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Certain verbal and nonverbal behaviors by physicians are associated with favorable patient outcomes

Patients who participate with their doctors in medical decisions affecting their health are more likely to comply with treatment recommendations. However, such joint decisionmaking usually depends on good physician-patient communication, which is not always the case. A new study has identified certain verbal and nonverbal approaches that seem to improve communication between primary care doctors and their patients, as well as patient outcomes.

Researchers from the University of North Carolina reviewed studies conducted from 1975 to 2000 that used neutral observers to evaluate office interactions between primary care physicians (PCPs) and patients. They analyzed 14 studies of verbal communication and 8 studies of nonverbal communication.

Verbal behaviors related to gathering information, relationship development, and decisionmaking and management were positively associated with short-term health outcomes (patient recall, satisfaction, intention to comply, and trust), intermediate outcomes (compliance with therapy), and long-term outcomes (symptom resolution, health status, quality of life, and mortality). These behaviors included empathy, reassurance and support, various patient-centered questioning techniques, increased visit time, more time spent on history taking, explanations of treatment, humor, psychosocial talk (focused on problems of daily living, social relations, feelings, and emotions of the patients), time spent on health education and information sharing, friendliness, courtesy, and summarization and clarification of findings.

Nonverbal behaviors that suggest interest in the patient and were positively associated with outcomes included head nodding, forward lean, direct body orientation, uncrossed legs and arms, arm symmetry, and less mutual gaze. Unduly dominant, attentive, nervous, and directive behavior by the doctor should be avoided, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00032).

More details are in "Physician-patient communication in the primary care office: A systematic review," by Rainer S. Beck, M.D., Rebecca Daughtridge, and Philip D. Sloane, M.D., M.P.H., in the January 2002 Journal of the American Board of Family Practice 15, pp. 25-38.

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