Conversation depends on two people talking to each other and, hopefully, being heard and understood. But there are a host of unspoken cues that are conveyed which have nothing to do with words—but have everything to do with interpretation and meaning.
Did you know that putting your hand out with palm facing the other party (we might understand the motion as “stop”) can mean, “I want to rub your face in something disgusting,” or patting someone on the head to show concern can be deemed wildly offensive and a threat to the person’s soul?
Welcome to the world of verbal and nonverbal communication, otherwise known as haptics and proxemics. Haptics are the things you can see, including age of the patient, sex, and manner of dress, and have been referred to as “the tip of an iceberg above water.” Proxemics refer to all the other things below the surface, including culture, attitudes, thoughts, and perceptions.
One must be aware of the “unspoken cues” of conversation. I learned this lesson the hard way when I performed an eye exam on a patient with several of her family members in the room.
Typically, I will finish an exam by asking the patient and family members if they had any questions. In this situation, seeing there were none, I gave what I thought was an innocent “thumbs-up” hand gesture to conclude the exam and indicate all was well with the patient. Unfortunately, that gesture was not received innocently, and significant drama occurred.
I was made to realize that my “thumbs-up” was not a friendly gesture in all cultures. In the end, I apologized to the patient and her family because they were guests of my practice. In reality, it was my responsibility to know better and make things right.
Talking to patients
I know this seems obvious, but talking to patients is what we clinicians do, so we’d all better be good at it. We talk to patients to provide them with our professional understanding of their condition. It matters what is said. The details matter, the context matters. Gender, age and cultural awareness all matter. The diagnosis matters.
What if the information relayed might be only half of the conversation? What if things like body language, tone, choice of words, and personal deference all mattered and were important components to include in the conversation? In fact, if you don’t start the conversation off properly, the conversation might be over before it begins. Indeed, the “recipe” for combining all these ingredients may vary from patient to patient.