Importance of nonverbal communication in the patient encounter

Background: Past studies of physician communication skills and patient satisfaction have shown a positive correlation between the two. The studies haven't addressed how the quality of information elicited from or provided to the patient varies with physician communication skills. Methods: Subjects were 12 residents in a combined medicine/pediatrics residency, who participated in a 13 station Clinical Performance Exercise in November, 1997. Stations were 15 minutes long; 9 used standardized patients (SP). After completing a station, the SP rated the resident on the quality of the information elicited or provided, and on general interview skills. Two stations were videotaped and analyzed for physician nonverbal behaviors. These stations were: 1) telling a mother her child had cystic fibrosis, and 2) counseling a woman with chronic pain and depression, who if questioned directly and empathically, gave a history of childhood sexual abuse. Factor analysis of the nonverbal behaviors resulted in four distinct factors: "warmth" and "calm" behaviors, body position, and speech characteristics. Results: At the cystic fibrosis station, patient satisfaction correlated with the nonverbal "warmth" (r=0.97) and "calm" (r=0.63) behaviors,and with body position (r=0.91) but not with quality of the information provided (r=0.11). At the abuse station, only half of the 12 physicians uncovered the history of abuse. Those who did were rated as significantly calmer (p<.05) and as having a more interested, less bored tone of voice (p<.05). Patient satisfaction correlated with ratings of physician warmth, posture, and calmness (r all>0.75). Further, patients felt significantly more satisfied with the interaction if the physician elicited the history of abuse (p<.05). Conclusions: In emotionally-charged encounters, physician nonverbal communication skills are important for eliciting sensitive information as well as for improved patient satisfaction.