The following piece by Son Trinh, DPT, ran in Putmebacktogether.com. I thank the handful of Ankota customers who shared it with us and suggested that we run it on our blog. These customers happen to be home health physical therapy and occupational therapy agencies, but the suggestions certainly to hold true for any caregiver dealing directly with patients. Enjoy!
1. Make eye contact (or not). As long as it’s not accompanied by a scowl and raised hackles, eye contact usually says, “I’m paying attention to you. You matter and what you say matters.” Averting the eyes may send the opposite message, keeping the proverbial ice as unbroken as ever.
On the other hand, universal rules aren’t always so universal. With patients from non-western cultures, the eye-to-eye connection might be read as intimidating, threatening or overbearing. Just as eye contact can be seen as a sign of warmth, it can just as easily be seen as an invasion of emotional and mental space.
The rule: Most of the time, eye contact is good. Just be aware of broad cultural differences as well as the individual response you elicit from your patient. After that, vary your response depending on their reaction to you. The worse thing you can do is engage your patient in a Klingon death-stare until they reciprocate.
2. Listen. As they say, we’re born with two ears but only one mouth. This should clue us in to how important it is to listen first and speak second. Great clinicians know that in the diagnosis, the key to their analysis about what’s going on lies in what the patient says.
For rapport-building, listening also helps you to identify the patient’s needs, wishes and fears. This becomes the basis for setting goals and for giving patients a chance to “tell the story” in their own words and in their own way. Patients who are allowed to speak feel validated and this helps them to open up to you.
3. Focus on the patient. This tip is closely related to number two. However, the idea is to talk, but about patients or things directly relevant to them. If you want to melt through the ice fast, listen, then ask questions or talk about things that interest your patient. Just be sure you can quickly segue into the clinical interview as it can be dangerous to wade into irrelevant waters and not have a line to tow you back.
As much as patients want to hear a point-by-point recounting of your recent expedition to the Arctic tundra, perhaps they will be more interested in you asking them about and commenting on their hobbies.
This doesn’t mean you can’t talk about yourself. Just keep the focus on them. For example: “Sounds like you like to travel. I recently went to Maine. Have you ever been there?” Look for common points and stick to them. Pause often, ask questions, and follow your patient’s lead.
4. Pay attention to body language. If you’re only listening to what the patient says you may be missing ¾ of the iceberg. For example arm-crossing can signal anxiety or anger, face-touching may reveal embarrassment and nose-scratching might be a sign of irritation or dishonesty. Some signals are difficult. A smile can mean openness and joy or it can be a sign of embarrassment, disagreement or it can say “you have major B.O. but I’ll be polite and smile instead of wrinkling my nose.”
As with eye contact, there are few universals and many exceptions. The message conveyed depends on many factors including posture, proximity, cultural background, tone, volume, hand position, facial expression and gesture.
Unless you’re an expert decoder, understanding body language might seem too difficult. The key is to use all the information available, including what the patient says and the constellation of body-language cues they send.
Of course, you should pay attention to your body language too, especially if your patient has a B.O.problem.
5. Smile. It’s not always easy to smile. Maybe today was the day cow-licks are growing like weeds on your head. Maybe your wife also ran over your foot while backing up with the Ford Explorer and the mint latte turned out to be vanilla nut and ended up in your lap instead of your mouth. Murphy’s Law may be operating in full effect today, but that doesn’t change the first thing you should do. Smile.
Healthcare means showing that we care. Nothing does that better than a smile. The irony is if you’re a little blue on the inside but choose to smile on the outside your mood can change. And when you’re in a good mood, chances are your patient will be in a good mood too.
Voila. Ice is melted.