When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for the patient — it’s their life on the line. Therefore, when any patient sees us, a huge number of them (if not the majority) are going to be a bit nervous. It’s important physicians recognize this. Doing so will help us do our job much better. As human beings, we innately have an ability to almost immediately perceive nervousness or anxiety in others (it’s something that goes back to caveman days as a basic survival mechanism). There are lots of body language signals that give this away, including very subtle things such as how someone blinks.
I wanted to briefly summarize three of the most easily noticeable:
1. Touching the face and neck. Someone who is nervous will often unknowingly keep touching their face and neck when they talk to you (males and females typically touch their face and neck area in different ways, but that’s a whole other topic). This happens for a couple of reasons, including a subconscious “protective” mechanism to guard from danger. Touching the neck also stimulates nerves which help relax us, and lower our pulse and blood pressure. In psychology, these are called “pacifying behaviors.”
2. Fidgeting a lot. We probably already recognize this habit, but watch the person’s hands and whether they are grabbing at anything, shifting around in their chair, or seem like they are easily distracted in general. That’s not necessarily a sign of rudeness, so don’t take it personally! It’s simply a way of expending that nervous energy and responding to stress hormones (cortisol and adrenaline) which are priming them for a “fight or flight” response.
3.Talking too fast. This can, admittedly, be annoying for a busy physician who feels like they just want to “get to the point.” However, not only is listening and observing the cornerstone of good communication, it also enables us to watch for some of those other body language signs. Talking too fast and going off in tangents, are telltale signs that those stress hormones are up and there is nervous energy to expend. Your patient may feel like they have the weight of the world on their shoulders, with so much they want to get off their chest.
So why is this important? Well, the practice of medicine is nothing without compassion and empathy. It is quite unlike any other field or “industry.” It’s an intensely emotional arena. Several weeks ago, I wrote an article about how patients have judged physicians only seven seconds after meeting them. Human snap judgments apply both ways. Within seven seconds, doctors can also frequently pick up subtle cues about the emotional state of any patient, nervousness being one of the main things to watch out for. We just need to tune into this. By observing and being aware of the classic signs of anxiety and concern, it is easier to do the true job of the good doctor: putting them at ease. As a professional, it’s totally within our power to do this. Or as the father of medicine, Hippocrates, timelessly advised over two millennia ago: “Cure sometimes, treat often, comfort always.”
Suneel Dhand is an internal medicine physician and author. He is the founder, DocSpeak Communications and co-founder, DocsDox. He blogs at his self-titled site, Suneel Dhand.
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