The next patient was a 25 year old female in room 2. The nurse’s note read, “severe abdominal pain – rates it a 10 out of 10.” Like any good emergency medicine physician, I was already considering the differential diagnosis prior to entering the room. Severe pain in a young female could be an ectopic, an appendicitis or a torsed ovary. I was prepared to perform a quick history and physical, order pain medications for the severe pain and hopefully not miss a catastrophic illness. I was surprised upon entering the room to find a patient sitting upright in the stretcher eating a bag of Fritos and laughing with her boyfriend.
Should my differential change? Why? The nurse’s note is still correct. The patient did state that she has severe pain and it is probably still rated a 10 out of 10 on her scale. (I didn’t ask). My impression of the patient’s level of illness and the patient’s credibility changed in an instant just by observing her actions. It would be very hard for her to get that creditability back, wouldn’t it? What changed? Why did she lose her credibility? Body language.
I was always taught that a good ED clinician should be able to determine a patient’s acuity of illness by observing the patient from across the room. How? Body language. Words have indisputable definitions but they still can mean different things to different people. Conditions and emotions that cause us to move or act in a certain way is more universal and unaffected by personal definitions.
An astute clinician can usually tell if the patient has a torsed ovary or a severe case of appendicitis by their body language. The “severe pain” that is rated as a 10 is important but not as much as the body language. If we can draw conclusions about patients from their body language, is the opposite also true? What can patients tell from our mannerisms and actions? I know that I should walk into a room and show empathy and have good listening skills. I know that this patient is not worried about the patient in room 6 with chest pain, nor should they be. They are only concerned with their abdominal pain and desire our undivided attention. Furthermore, I don’t want a patient to complain and I want to do well on the patient satisfaction survey.
Does my body language make a difference? You bet it does. I can ask each patient if they are feeling better. I can ask them if they have any questions. Does it matter if I appear rushed or tired? Case in point. I read a book recently called “My Stroke of Insight” by Jill Bolte Taylor, a neuroanatomist at Harvard, who had spent years studying the brain. She unfortunately had a brain hemorrhage.
The book is about her thoughts during the time of the hemorrhage and how she noticed her brain recovering on the cellular level. I want to focus on how she describes her time immediately post stroke when she was still aphasic and in the hospital. “Because I could not speak or understand language, I sat silently on the sideline of life…..Although I could not understand the words they spoke; I could read volumes from their facial expressions and body language.
Dr. David Greer was a kind and gentle young man. He was genuinely sympathetic to my situation and took the time to pause during his busy routine to lean down near my face and speak softly to me. He touched my arm to reassure me that I would be okay. Although I could not understand his words, it was clear to me that Dr. Greer was watching over me. He understood that I was not stupid but that I was impaired. He treated me with respect. I’ll always be grateful for his kindness. ”No words were spoken but she was comforted and gained confidence in the doctor and in her recovery. His body language alone comforted her.
Several prominent communication specialists have demonstrated that 7% of the impact of our communication comes from the words that we choose while 38% comes from the tone of voice and 55% is achieved with our body language.
So what can we do to improve the way we use our body language in speaking with patients? Eye contact; both with the patients and with every family member in the room. As mentioned by Jill Taylor, human touch sends a message in itself, shake everyone’s hand, sitting down next to the patient when speaking rather than standing near the doorway or curtain, these are just some ideas. I would welcome others.
I want to close with a quote from Randy Pausch, author of “The Last Lecture” just months prior to his death. “The display of sincere emotion is not terribly complicated and it is always moving to human beings. It is surprisingly easy to recognize. This can be learned by watching people tell you a story in a language that you do not understand. You realize before you get the translation whether you believe what they are saying and whether you care. Sincerity translates on a far more primal level than language.”