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Non verbal communication at the medical centre.

(Thanks to SusanaGarciaDiez @sgd_2011 for the translation from Spanish!)

Non verbal communication at the medical centre.

A non formal proposal to begin with thinking about doctor’s non verbal communication

Transcription of the audio: Questions about health could be doubts…..but there aren’t doubts is a worried that your health deserves…..because the doctor’s expression is the best diagnosis…Dr vaca the comment that the patient needs when is about his health….Dr Vaca (and his adress) Avda Gral sagol Avellaneda), the Peter Capusotto(stand up comedian) character. At the parody, the doctor take the patient’s pulse,auscultate, watch a X-ray of the chest…and he only gives out a sound non so much encouraging while an off voice sentences “…..because the doctor’s expression is the best diagnosis”
On his book “Non verbal communication” Sergio Rulicki defines it as a complementary language to the words and transmit through different channels: it talks but through the body.
Constantly patients test the non verbal capacity of the doctor by his ability of generate reactions with almost everything they bring to the consulting room: particular matter, his way of explain it, his explanations and interpretations, his questions, his physical appearance and his feelings. Also the findings about physical examination, the tests results and even the family of the patient generate reactions.
This huge volume of emotions develops a physiological and psychological pressure that is expressed outside on gesture, positions, ways of talk, manners, that the doctor express continuously, on an unwitting way and didn’t ever notice or have the possibility of control or avoid them.
People, on this way, are the conjunct of inherited plus acquired expressions through our particular culture (family, Country, region, genre, economic status and power status), base of body-language over there are added that who are characteristics of our profession and, of course, our own repertoire. There are overstrike to all them that of the specific moment we are living on, the expressions that talk about our personal and professional life, the same way as the degree of pleasure or dissatisfaction with we are doing or the place where we work.
Emotions, physiological / psychological pressure and body movements, all the time. Following this path hidden messages are built and transmit that reinforce or contradict what our words want mean. At other times, when is better not say or when we don’t know how- replace them.
Our non verbal comunication, through its differents ways, talks to the patients about how we feel interacting with them, if we like or push away them, if we are attentive or unfocused, how we value what we see and listen, if we are being honest or simulating.
Patient -doctor relation is a relation face-to-face, direct and with a high level of emotional contents and as such as, patients seek (and often find and others believe find ) in the face, look, gestures and doctor’s movements information that they do not comprise through an encrypted verbal language or what they suspect that doctor is hiding them .
They want to give , at last resort , with some signal of responsiveness : will there be paying attention to what I said ?, Has he understood me ?, has he achieve to understand how I feel ?
The context in which we move, there is know, is favourable to the suspicion: It exists lately a basal distrust of systems and health professionals, distrust which is enhanced by ever shorter consultations, and anxieties and increasing fears each time highers.
Hence, all or nearly all can be a source of information-objective or subjectively. Some alone have a specific weight as carrier messages, but in most cases patients arrive at a conclusion by integrating evidence and applying a logic or a difficult code to express in words but they give the person the sense of certainty about what is perceived and the presence or otherwise of a gesture that reflects clearly intended the doctor to accompany and get involved:
How to shake hands when receiving and dismissing the patient: looking or not looking at the eyes, with the body from the front or standing side on, strong or weak, short or long, with arm bent or stretched.
How fast we talk, questioned, reviewed, or do we see the tests or written the prescription.
If we make eye contact when listening to the patient or when we communicate information and relevant decisions, or we distance ourselves looking at the computer screen.
If we review fully and systematically, or just hinting hand or stethoscope through their clothes, or directly nor do.
If we physically positioned above or to the same level.
Moreover, taking office as territoriality, we can adapt the scheme from A. Mehrabian about 5 Perceptions of Space: formality, Warmth, Privacy, Familiarity, Compulsion and Distance:
Do we attend the patient with the door of the consulting room open or closed?
Do we Tolerate entering and leaving others during the consultation?
Does the stretcher is available or busy with our belongings?
Are the walls are free or have diplomas, pictures, or pictures of the Pharmaceutical industry?
Some examples, common postcards see every day and in which we are all voluntarily or involuntarily, with or without awareness of them players, its impact and importance as sources of warmth or detachment, as facilitators or inhibitory in an intimate and open communication, as a statement of principles for a model doctor-patient relationship built on a dominance and compliance relation or,instead, parity and respect for autonomy.
There is no doubt that for helping patients need to know medicine; however, Doctors usually have an excessive and disproportionate confidence that our scientific knowledge and self-education in communication and will reach enough to achieve the most important goals of a query. That Is not always the way.
Communication, verbal and non-verbal, is a path that doctors travel inevitably and intuitively (inevitably intuitively). Exploring and experimenting under the principle of trial and error developed a product that without another choice we end confident but without know depthly the extent of its effectiveness.
In some countries training on doctor-patient communication It is mandatory, however, until in our midst this preparation is not massive and formally incorporated in the medical education and the approach will depend on individual initiative, and in this regard, virtual book of Dra. M. del Carmen Vidal and Benito Intramed published a few years ago reading is required.
As any new attempt requires a jerk and accept pursue a special type of proposal, far more committed than the beginning, and F. Savater has managed to put in words: “Remediation basic ignorance about a topic with some passion.”
Dr. Ruben Mayer

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