- Email: [email protected]
The Hidden Meaning of Body Language
The Hidden Meaning of
Body Language By HELEN SPENCER
Before the first word is spoken between you and your patient, communication has begun. Eye contact, a quick smile, the manner of walk or stance-all are signals that can be transmitted and read . Experiments introducing conflict among facial expression, vocal tone and verbal content have concluded that facial expressions account for 55% of the impact of feelings communicated between two people; vocal tone and inflection account for another 38%; vocabulary accounts for only 7%. 1 It is easy to see, therefore, that pharmacists cannot ignore the nonverbal component of patient communication. It is important for the pharmacist to achieve the level of . trust and confidence from the patient that assures adherence to therapy and/or a continuing helpful relationship. 2 Nonverbal communication is also an indication of the patient's true emotional state about the medical problem or therapy. Patients may be reluctant or embarrassed to verbalize feelings; consequently, the words used by patients may not be congruent with the nonverbal expressions of their emotions.
Body Language Skills Pharmacists who are aware of their own body language and are able to interpret their patients' nonverbal messages rapidly and accurately can strengthen their relationships with patients and be attentive and sensitive to their patients' hid-
Helen Spencer, PharmD, is an assistant professor of pharmaceutics at the University of the Pacific School of Pharmacy, Stockton, CA 95207. 48
exchange but also the context and environment of the interaction. Analyzing nonverbal messages out of context can lead to potential ambiguities in interpretation. Facial expressions are perhaps the most easily read nonverbal signs. Six facial expressions have been found to be universal across cultures (see figures, opposite page). The specific events stimulating the emotional response and the facial display of that emotion, however, are learned and culturally determined. 9 Pharmacists who provide services to patient populations comprising particular racial or cultural groups should learn the appropriate interpretation of the nonverbal behaviors of those groups. Individualized expressions learned in social groups or taken on as personality traits further complicate the task of interpreting nonverbal behaviors.10 In addition, patients seem to demonstrate a unique set of body movements for expressing illness and related emotional changes.ll These include self-manipulating A Coding System movements such as wringing the A system for coding body movehands, licking the lips or scratching ments was pioneered by Ray Birdthe nose or face during stressful whistle, an anthropologist and linsituations. In order for pharmacists to use guist. 3 He reasoned that, like the their nonverbal communication rules by which the 26· letters of the skills for effective patient coun· alphabet are arranged to form words and sentences conveying a seling, they must spend time with particular message, body movethe patient. It is difficult for the ments, too, are not isolated events. pharmacist to give full attention to patients to observe subtle, non· They occur in clusters when a mesverbal behaviors, however, because sage of particular meaning is inall too often the pharmacist's atten· tended. tion is diverted by drug dispensing This approach has been popuand other competing demands in larized in several recent books. 4 ' 5 the environment. Limitations of this linguistic or kineThe pharmacist who learns to use sic approach, particularly in the interpretation of various movements, _ _ time well and to deal effectively with the patient based on nonverbal have led to the development of addias well as verbal signals may make tional models for the study of nonthe difference between a therapeutic verbal behaviors. 6' 7' 8 failure and success. o A more useful model for pharmacists takes into account not only the (References on p.56) nonverbal actions that two people
den needs and fears. These fears may intensify patients' response to pain, delay recognition of illness, or interfere with prescribed therapy. The pharmacist's success in using these skills depends, however, on the context of the pharmacist's interaction with the patient and the time needed to help the patient resolve concerns before proceeding to the information-giving stage of the patient consultation. Reading body language is a skill . that can be developed and applied in any practice setting. And a growing body of knowledge about body language can help the active pharmacist interpret the hidden messages. Observations of particular value for patient consultation include use of personal territory or space, mannerisms, gestures, body posture, facial expressions, eye contact, and speech inflection. Research into these aspects of human behavior crosses the disciplines of anthropology, sociology, psychology, and communication arts.
American Pharmac Vol. NS21, No. 7, Jul 1981/4
Elelllents of Nonverbal ,.E xpressions Facial expressions
Happiness
Surprise
Fear
Ang,er
Extreme Anger
su'rround themselves with a bubble of personal territory w.Jth the"individl.lal. Any intrusion into this personal as'' ,rude behavior. [n contrast, Middle Eastern people do "~' .·. prfy"te space. Pushing and shoving are acceptable behavJ~rs jn .· cultU:,t:es l1ecause as a person moves into a space they claim rights l~' tha~ new sease w ~~
;,
~mericans indicate agreement, support and affirmation by nodding the head ~lowly. Fast head nods signal that the listener wants to speak. The shake of the head from side to side indicates disagreement to Americans, whereas in the Bulgarian culture it is a sign of agreement.
Body postures
In the Western culture, body postures indicating cooperation include leaning forward, tilting the head to one side, placing hands on hips, unbuttoning the coat, using pensive or thoughtful hand-to-face gestures, ~nd/or moving in to speak confidentially.
Eye contact
Americans tend to look each other in the eye 25-75% of the time when speaking. Eye qJntact decreases when emotional subjects are discussed. Orientals, however, are taught to commpnicate re~pect by decreasing eye contact with the speaker and will often look at the floor when speaking.
Speech infiection
Pauses and sounds such as uh, umm or ah are common interjections in the verbal message; use of these sound.s increases when the speaker is under stress.
American Pharm
7
49
Body Language By HELEN SPENCER
Before the first word is spoken between you and your patient, communication has begun. Eye contact, a quick smile, the manner of walk or stance-all are signals that can be transmitted and read . Experiments introducing conflict among facial expression, vocal tone and verbal content have concluded that facial expressions account for 55% of the impact of feelings communicated between two people; vocal tone and inflection account for another 38%; vocabulary accounts for only 7%. 1 It is easy to see, therefore, that pharmacists cannot ignore the nonverbal component of patient communication. It is important for the pharmacist to achieve the level of . trust and confidence from the patient that assures adherence to therapy and/or a continuing helpful relationship. 2 Nonverbal communication is also an indication of the patient's true emotional state about the medical problem or therapy. Patients may be reluctant or embarrassed to verbalize feelings; consequently, the words used by patients may not be congruent with the nonverbal expressions of their emotions.
Body Language Skills Pharmacists who are aware of their own body language and are able to interpret their patients' nonverbal messages rapidly and accurately can strengthen their relationships with patients and be attentive and sensitive to their patients' hid-
Helen Spencer, PharmD, is an assistant professor of pharmaceutics at the University of the Pacific School of Pharmacy, Stockton, CA 95207. 48
exchange but also the context and environment of the interaction. Analyzing nonverbal messages out of context can lead to potential ambiguities in interpretation. Facial expressions are perhaps the most easily read nonverbal signs. Six facial expressions have been found to be universal across cultures (see figures, opposite page). The specific events stimulating the emotional response and the facial display of that emotion, however, are learned and culturally determined. 9 Pharmacists who provide services to patient populations comprising particular racial or cultural groups should learn the appropriate interpretation of the nonverbal behaviors of those groups. Individualized expressions learned in social groups or taken on as personality traits further complicate the task of interpreting nonverbal behaviors.10 In addition, patients seem to demonstrate a unique set of body movements for expressing illness and related emotional changes.ll These include self-manipulating A Coding System movements such as wringing the A system for coding body movehands, licking the lips or scratching ments was pioneered by Ray Birdthe nose or face during stressful whistle, an anthropologist and linsituations. In order for pharmacists to use guist. 3 He reasoned that, like the their nonverbal communication rules by which the 26· letters of the skills for effective patient coun· alphabet are arranged to form words and sentences conveying a seling, they must spend time with particular message, body movethe patient. It is difficult for the ments, too, are not isolated events. pharmacist to give full attention to patients to observe subtle, non· They occur in clusters when a mesverbal behaviors, however, because sage of particular meaning is inall too often the pharmacist's atten· tended. tion is diverted by drug dispensing This approach has been popuand other competing demands in larized in several recent books. 4 ' 5 the environment. Limitations of this linguistic or kineThe pharmacist who learns to use sic approach, particularly in the interpretation of various movements, _ _ time well and to deal effectively with the patient based on nonverbal have led to the development of addias well as verbal signals may make tional models for the study of nonthe difference between a therapeutic verbal behaviors. 6' 7' 8 failure and success. o A more useful model for pharmacists takes into account not only the (References on p.56) nonverbal actions that two people
den needs and fears. These fears may intensify patients' response to pain, delay recognition of illness, or interfere with prescribed therapy. The pharmacist's success in using these skills depends, however, on the context of the pharmacist's interaction with the patient and the time needed to help the patient resolve concerns before proceeding to the information-giving stage of the patient consultation. Reading body language is a skill . that can be developed and applied in any practice setting. And a growing body of knowledge about body language can help the active pharmacist interpret the hidden messages. Observations of particular value for patient consultation include use of personal territory or space, mannerisms, gestures, body posture, facial expressions, eye contact, and speech inflection. Research into these aspects of human behavior crosses the disciplines of anthropology, sociology, psychology, and communication arts.
American Pharmac Vol. NS21, No. 7, Jul 1981/4
Elelllents of Nonverbal ,.E xpressions Facial expressions
Happiness
Surprise
Fear
Ang,er
Extreme Anger
su'rround themselves with a bubble of personal territory w.Jth the"individl.lal. Any intrusion into this personal as'' ,rude behavior. [n contrast, Middle Eastern people do "~' .·. prfy"te space. Pushing and shoving are acceptable behavJ~rs jn .· cultU:,t:es l1ecause as a person moves into a space they claim rights l~' tha~ new sease w ~~
;,
~mericans indicate agreement, support and affirmation by nodding the head ~lowly. Fast head nods signal that the listener wants to speak. The shake of the head from side to side indicates disagreement to Americans, whereas in the Bulgarian culture it is a sign of agreement.
Body postures
In the Western culture, body postures indicating cooperation include leaning forward, tilting the head to one side, placing hands on hips, unbuttoning the coat, using pensive or thoughtful hand-to-face gestures, ~nd/or moving in to speak confidentially.
Eye contact
Americans tend to look each other in the eye 25-75% of the time when speaking. Eye qJntact decreases when emotional subjects are discussed. Orientals, however, are taught to commpnicate re~pect by decreasing eye contact with the speaker and will often look at the floor when speaking.
Speech infiection
Pauses and sounds such as uh, umm or ah are common interjections in the verbal message; use of these sound.s increases when the speaker is under stress.
American Pharm
7
49