Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer.

Verbal communication in medical consultations is well recognised as being important to the delivery of medical care and is usually easy to interpret and analyse. It is discrete with clear endpoints, it occurs in a single mode, it is mostly under voluntary control, and communicates our cognitive thoughts more than our emotions. In contrast, non-verbal communication is less easy to interpret: it is continuous even in silence, can occur in several modes at once, operates at a less conscious level, leaks spontaneous cues, and is the channel most responsible for communicating attitudes, emotions, and affect.1,2 We should not be surprised, therefore, that non-verbal communication plays a significant role throughout the medical interview and is an important variable in doctor-patient interactions. Non-verbal communication helps to build the relationship, provides cues to underlying unspoken concerns and emotions, and helps to reinforce or contradict our verbal comments.3 Non-verbal communication is at its most significant in the medical interview if it contradicts the message from verbal communication. When the two are inconsistent or contradictory, non-verbal messages tend to override verbal messages.3 This explains why a closed question accompanied by effective non-verbal communication will often lead to an open answer, and why patients do not necessarily believe a reassuring verbal comment if accompanied by contradictory facial expressions and vocal hesitancy. Two intimately related aspects of non-verbal communication in the interview require consideration: the non-verbal behaviour of patients and the non-verbal behaviour of doctors. As doctors, we need to recognise and explore patients' non-verbal cues in their speech patterns, facial expressions, and body posture. But we need to be equally aware of our own non-verbal behaviour: how the doctor's use of eye contact, body position and posture, movement, facial expression, and use of voice can all influence the success of the …