Doctor Patient Relations

How Patients View Us: Know Your Non-Verbal Cues

By Jennifer Jabaley, OD

May 4, 2016

Understanding the way patients perceive us–often by body language and vocal intonations that we don’t think about–guides how we can better serve their needs.

Everyone’s heard the old expression, “love at first sight.” For most of us realists, we roll our eyes and marvel at the overly emotional romantics. But as I get older, I realize that there are times when I have an immediate comfort level or affinity toward a complete stranger. An instant friend.

We all know the practice management mantra that patients don’t sue doctors they like. And patients’ word-of-mouth referrals sky-rocket if they feel a personal connection to their doctor. So, I began to wonder, what is the psychology behind snap judgements and immediate connections?

The Power of Thinking Without Thinking

According to Malcolm Gladwell’s book, Blink, the part of our brain that leaps to conclusions is called the adaptive unconscious. It’s like a giant computer that quickly processes a multitude of data, sizing up the world in an unconscious manner. When we meet someone for the first time, it’s this part of our brain that fires.

Psychologist Nalini Ambady did a research study, showing a group of students three different 10-second videos of unfamiliar teachers in a classroom. The sound of the videos was turned off. The students were asked to rate the teachers’ effectiveness based on the silent 10-second videos.

The results from the group were remarkably consistent. After the rankings, the students then sat through several classes taught by those same three teachers. They were asked to reevaluate the teachers’ effectiveness. Compared to the initial snap judgements of 10-second silent videos, the evaluations after a semester of classes were essentially the same. That’s the power of our adaptive unconscious and its ability to decipher body language.

Isn’t it easy to conclude that our patients do the same thing? They make snap decisions about our effectiveness within a very short time of meeting us. In a study done in 2005, published in Medical Journal of America, 400 patients were shown one of four sets of photos of doctors. Each set of photos showed:
• a doctor in “business” attire without a white lab coat
• the same doctor in “professional” attire with a starched white lab coat
• the same doctor in scrubs and sneakers
• the same doctor in T-shirt, jeans and sneakers
The 400 respondents were asked a series of questions, such as: “Which would you prefer to be your doctor?”, “Which of these doctors would you trust the most?” and “Which of these doctors would you expect to be most knowledgeable and competent?”
On average, across all the questions, 76 percent of respondents chose the professional attire with starched white jacket, followed by business attire and scrubs. The casual look attracted just 4.7 percent of the vote, although interestingly, it scored more highly in questions that probed whether doctors looked “caring and compassionate.”
We might not want to think that patients make snap judgements about our ability based on our attire and appearance, but clearly they do.

Body Language

Ninety-three percent of communication is nonverbal. Between 50-85 percent of communication is conveyed through body language. Posture, bearing, gestures and gate reflect personality traits. For example, holding eye contact communicates interest or curiosity. Smiling indicates someone is agreeable and enthusiastic. A closed mouth with no tension in the lips demonstrates openness to discussion. Showing the palms of your hands is inviting trust. Tilting your head to one side expresses interest and attention. Talking with your hands reveals confidence, excitement or generosity.

What are some common body language gestures that convey negative traits? A head thrust forward is perceived as aggressive. Drooping shoulders shows emotional burden. Evaded eye contact reveals disinterest. Rapid blinking indicates lying or distrust. Hands propped on the waist is a challenging, dominant posture.

Vic Braden, a professional tennis coach, could accurately predict up to 95 percent of the time when a pro tennis player would double fault even before they tossed the ball. He said he never looked at the ball toss, but rather had an innate ability to very quickly assess the confidence and concentration of the player simply through their body language.

Research shows that facial expression conveys the most information, and particularly the lips, mouth and jaw reveal the most emotion. There is an entire dictionary online of non-verbal gestures, signs and body language cues. What our movements reveal about our emotional state is remarkable.
Since I begin all my patient interactions with a handshake, I try to make that initial body language encounter a positive one. How we shake hands gives a lot of information about us. The handshake is absolutely of significance depending on the purpose of the meeting, the roles of the people meeting each other and the circumstances around the meeting. We often make judgments based on what we experience even in a handshake and it influences our perception of the other person. I always look the patient in the eye and smile. I feel like a firm handshake with a smile gives the impression that I’m confident, but accessible and friendly.

Let’s go back to the statement that patients don’t sue doctors they like. Alice Burkin, a leading medical malpractice lawyer says that the risk of being sued has very little to do with how many mistakes the doctor makes. Analysis of malpractice lawsuits show that there are highly skilled doctors who get sued a lot and doctors who make a lot of mistakes and never get sued. In other words, most patients don’t file a lawsuit because they’ve received bad medical care. Patients sue because they’ve been harmed by poor care and something else. What is that something else? Usually, it’s that they don’t like the doctor. Why?

If 93 percent of communication is non-verbal, and 50-85 percent is body language, what makes up the remaining information we communicate to patients? It’s not the words we say, but how we say them. Tone, pitch, quality and speed of our voices show the meaning behind the dialogue.


Medical researcher, Wendy Levinson, recorded hundreds of conversations between physicians and patients. Half of the group of doctors had previously been sued, the other half had never been involved in a lawsuit. Psychologist Nalini Ambady, took Levinson’s taped conversations, filtered out the individual words and just left the pitch and intonation of the voices. She did a group study where people listened to the garbled conversations between the doctors and patients and tried to predict which doctors were in the group that had been sued. The study group knew nothing about the doctors’ training and skill level. They didn’t even know what words the doctors were saying. And yet, by listening to the tone and pitch of their voices, the people could with extreme accuracy, pinpoint which doctors had been sued.

When asked to identify qualities of tone used to describe the doctors they thought had been sued, they used words like: hostile, anxious and dominant. Descriptors from the proposed non-sued group included: warmth and humor. It was noted that the rate of laughter in the non-sued group was more than double that of the proposed group of doctors they thought had been sued.

The study group’s predictions were over 90 percent accurate. The doctors who had been sued provided similar information, diagnoses, treatment plans and options. The main difference was how they spoke to their patients.

Remember: It’s More than Just Your Words

In the end, it’s interesting to examine a key aspect of human nature and how snap decisions and judgements are made on initial encounters. I still may not exactly believe in love at first sight. However, I do accept that certain non-verbal communication can lend itself to sending initial positive or negative messages upon meeting a stranger.

Knowing the power of our subconscious minds, we can aim to make better first impressions to our patients by training ourselves to focus on positive body language gestures and effective tone of voice.

What changes can you make to improve how patients perceive you? What have you noticed makes the greatest difference in how effectively you are able to interact with patients?

Jennifer Jabaley, OD, is a partner with Jabaley Eye Care in Blue Ridge, Ga. To contact her:


To Top
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.