When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.

Here are 5 tips that can help you navigate difficult patient interactions.

Tip 1. When someone raises their eyebrow, this is a sign that they are not feeling threatened. When you raise your eyebrow, it often elicits a smile from the person your are interacting with, so the next time you receive an eyebrow raise, know you have a good rapport with this person and they are comfortable with you. Why not try to foster a positive response from your patient by raising your eyebrows next time you talk to them? Maybe you will notice that they warm up to you easily.

Tip 2. A person’s eyes dilate strongly when they are stimulated by the conversation and are in a problem solving mode. You may use this to your advantage when you are discussing goals of care and the course of treatment. Paying attention to whether patients and family members have dilated pupils can give you a clue as to whether it is the right time to address important planning issues. When the pupils are dilated, chances are that decisions made will be positive ones.

Tip 3. The first person to look away in an introduction is the more submissive. This can be helpful to understand family dynamics, who the decision makers are, and who is most likely to be leading the family discussions. It can be helpful to determine the hierarchy within a family and whether the people you are dealing with are in a dominant role. They may wish to dominate you in the relationship, which may make the relationship difficult and may be something that you must pay attention to.

Tip 4. If a person’s eyes are moving around and darting from one object to another, they are either nervous or bored. The type of interaction you are having with them will tell you which is true. If you have engaged them in conversation for an extended period of time, you can make an assumption that the conversation is now boring for them. If the conversation is about a difficult subject matter, chances are, they are nervous. You might want to try to reassure them and comfort them if it is a necessary discussion.

Tip 5. A clue about whether someone is being open and honest is whether they are showing their palms. If palms are displayed, they are telling you the truth. If you talk with your palms facing upwards, it forces others to speak truthfully too.

Niamh van Meines is a nurse practitioner who blogs at Hospice Navigator.

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