It may sound cliché, but it’s true: actions often speak louder than words. Don’t get me wrong, strong verbal communication skills are essential to the success of any relationship, including the one between a patient and his or her provider. However, there are times when a patient’s actions will tell you one thing while his or her words tell you another—and therein lies the importance of nonverbal communication in health care. It’s not that patients are intentionally trying to mislead you. Often, nonverbal cues can tell you things patients weren’t even aware of themselves. As a rehab therapist, understanding these nonverbal cues can be the difference between a patient who feels neglected and a one who feels like his or her therapist truly cares. And when your patients feel understood, they’re far more likely to stick with therapy. In fact, one study found that 85% of patients surveyed either switched providers or considered leaving their current provider due to that provider’s poor communication skills.

On the flip side, strong nonverbal communication skills appear to correlate positively with patient satisfaction scores. During a study that analyzed interactions between patients and providers, researchers found that providers who maintained eye contact—instead of focusing on their computers—consistently received higher patient satisfaction ratings. So, the message is clear: if rehab therapists want to keep patients engaged in their care plans, then they must exhibit high-quality communication skills that extend beyond the spoken word. With that in mind, here are four ways your patients communicate without speaking:

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1. The patient says one thing, but his or her facial expression says another.

Human faces are incredibly expressive, and a person’s facial expression can tell you a lot about what he or she is thinking. In fact, a person’s expression can even affect his or her voice inflection. Have you ever noticed that when you speak to someone on the phone, you can tell when that person is smiling? That’s a perfect example of how expression affects communication. Expression can also tell you if a patient is in pain or experiencing discomfort. Ideally, a patient will tell you if an exercise is too difficult or painful, but some patients may be embarrassed to admit when something is too much for them. So, by paying close attention to their expressions, you can make sure patients don’t injure themselves or become discouraged due to pain.

2. The patient avoids eye contact or fidgets while speaking.

Obviously, therapy often comes with a lot of physical demands, but it can also take a toll on your patients’ emotions. Therapy often requires patients to be completely vulnerable, and that doesn’t come easily to everyone. If you notice that a patient has a hard time maintaining eye contact—or if he or she appears restless and fidgety while speaking to you—it could be a sign that the patient is feeling anxious or embarrassed.

When you notice that a patient is visibly tense, it’s important to remain empathetic. Remember that therapy isn’t just about healing the body—it’s about healing the entire person. When you adopt this kind of holistic approach, your patients will take notice—and they’ll be more likely to feel a sense of loyalty toward you.

3. The patient starts talking less—or stops talking altogether.

Sometimes, when a patient grows suddenly quiet, it can be a sign of intense concentration. Other times, it can mean there’s a lot on the patient’s mind. But depending on the context, it may be a red flag that your patient is upset. This is where reading facial cues becomes incredibly important. Furrowed eyebrows are generally a sign of concentration, but if your patient seems withdrawn or distracted, he or she may be grappling with some difficult emotions. If that’s the case, step back and consider the whole picture: did he or she not achieve a recent goal? Is he or she struggling to get through the prescribed exercises? No matter what’s on your patient’s mind, make sure he or she knows you care—but also make sure you remain respectful of his or her privacy. If it’s something the patient isn’t willing to talk about, don’t press the issue. But, if the patient wishes to share, be an active listener and communicate from a place of empathy.

4. The patient has a stiff or defensive posture.

Posture can be tricky. Sometimes, a patient’s closed stance—crossed arms, for example—can come across as defensive when in reality, it’s simply comfortable for him or her. And if your patient is dealing with a functional disability, then what’s comfortable may not jibe with what society perceives as open, receptive body language. However, there are certain things people unconsciously do with their bodies—slouching or turning away from you, for example—that indicate a lack of engagement. And if a patient crosses his or her arms and legs—or if he or she displays other forms of closed body language—it could imply discomfort or defensiveness. Again, try to remain mindful of the current situation, and strive to be accomodating—without enabling negative behavior—when a patient is frustrated.

Culture can influence nonverbal communication.

The United States is incredibly diverse, which means that in a public-facing profession like physical therapy, you’re going to encounter a myriad of cultures and mindsets. Furthermore, just because you’re accustomed to communicating one way, it doesn’t mean your patients will always communicate in the same manner. For example, American culture views eye contact as a sign of interest or engagement. Conversely, certain other cultures—such as Latin American or Southeast Asian cultures—perceive consistent eye contact as a sign of disrespect or aggression. So, if your patient comes from a different cultural background than your own, his or her level of eye contact could imply something totally different from what you’ve been taught.

Emotional awareness strengthens nonverbal communication skills.

Strengthening your own nonverbal cues requires a great deal of understanding about your own emotions and how they impact you. This will also help you recognize certain emotions in your patients and help you respond intelligently. In other words, nonverbal communication is heavily influenced by an individual’s emotional intelligence (EQ). Providers who are emotionally intelligent can:

  • Pick up on nonverbal cues and accurately interpret intentions.
  • Strengthen relationships with patients by responding appropriately to patients’ nonverbal cues.
  • Respond to their patients with empathy.
  • Better meet the unique needs of their patients.

At the end of the day, the important thing to remember about communication is that personal experience can greatly influence the way we perceive and interpret nonverbal cues. Just because a patient is slow to react, for example, doesn’t necessarily mean he or she is upset. (Perhaps he or she simply stayed up a little too late the night before.) So, when in doubt, just ask—and when you do, make sure your questions come from a place of humility and sincerity.

Have more tips for reading nonverbal cues? Share them with us in the comment section below!

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