1. It’s not what you say but the way that you say it!
A brief guide to non-verbal communication in the GP setting
8th January 2018

2. This session… What is non-verbal communication?
Why is it important to me?
How can we improve our non-verbal communications?

3. What percentage of our communication is non-verbal?
93%
of our communication is non-verbal

4. Ice breaker

5. How did you manage that?
What is non-verbal communication?
Examples?

6. What is non-verbal communication?
Kinesics – body motions eg. shrugs, foot tapping, drumming fingers, winking, facial expressions, gestures
Proximity
Haptics – touch
Oculesics – eye contact
Chronemics – Use of time, waiting, pausing
Vocalics – tone, volume, speed
Sound symbols – grunting, mmm, er, ah, uh-huh, mumbling
Silence
Posture
Adornment – clothing, jewelry, hairstyle
Locomotion – walking, running, staggering, limping
Any idea what the researchers suggest are the most important ones in the medical setting?

7. What is non-verbal communication?
Kinesics – body motions eg. shrugs, foot tapping, drumming fingers, winking, facial expressions, gestures
Proximity
Oculesics – eye contact
Posture
Body language, particularly facial expression and gestures, eye contact, proximity and posture are those that we need to be aware of in terms of conveying meaning, avoiding misunderstandingas and fitting in with the target culture

8. Non-verbal communication as taught by ‘Friends’

9. Task: Wordless Acting In pairs -
Determine who will be person A, and who will be person B
Person A will read their lines out
Person B will communicate his/her lines in a nonverbal way
Person B will have an additional secret emotion which will be affecting them!
Can we guess the emotion?

10. Why does non-verbal communication matter?
93%
of our communication is non-verbal

11. Why does it matter? Rapport Cues… information gathering….
Are they on board?
COMPLAINTS & LITIGATION
Cultural context
Malpractice litigation is correlated with tone of voice

12. Thumbs up?
The thumbs-up gesture, which generally signals approval in English-speaking countries, is considered offensive in other countries, including apparently Greece, Italy and some parts of the Middle East.

13. OK?
Making a circle with your thumb and forefinger like this means OK in Western cultures. It is used in particular by divers in this way. In Japan, however, it is reputedly the sign for money, and in Arabic countries, it is a threat.

14. Danger: BEWARE of the risks of communicating without your non-verbal tools!
The constant miscommunication that occurs online is a direct result of the absence of nonverbal cues, not able to translate across a computer screen.

15. E.M.P.A.T.H.Y. E – Eye contact M – Muscles of facial expression
P – Posture
A – Affect
T – Tone of voice
H – Hearing the whole patient
Y – Your response
This acronym was the cornerstone of a randomized controlled trial of empathy training at Massachusetts General Hospital, Used as an easy-to-remember checklist, the acronym orients medical professionals to key aspects of perceiving and responding to nonverbal emotional cues. An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients' communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. 
E.M.P.A.T.H.Y.: a tool to enhance nonverbal communication between clinicians and their patients.

16. E.M.P.A.T.H.Y. Trial: Conclusion
“An urgent need exists to teach nonverbal aspects of communication as medical practices must be reoriented to the increasing cultural diversity represented by patients presenting for care. Where language proficiency may be limited, nonverbal communication becomes more crucial for understanding patients' communications. Furthermore, even in the absence of cultural differences, many patients are reluctant to disagree with their clinicians, and subtle nonverbal cues may be the critical entry point for discussions leading to shared medical decisions. ”

17. The End - Thank you