Body Language and Person-centered Care

Patient, or person-centered care, has several definitions. Two examples include:

• “Integrated health care services delivered in a setting and manner that is responsive to the individual and their goals, values and preferences, in a system that empowers patients and providers to make effective care plans together.”(1)
•  “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”(2)

Though definitions vary, supporting patient decision-making about health and health care is an essential ingredient in person-centered care.(3) Doing so involves communicating accurate and clear information that encourages open interaction and understandable choices. Verbal communication is perhaps the most obvious method. But clinicians also communicate nonverbally, through signs, posters, and office policies. We also communicate through body language.

A recent article published in the journal Frontiers in Psychology offers a novel approach toward applying person-centered care activities by studying how physician body postures communicate messages about shared decision-making.

Key Methods

The study recruited 167 adults from the U.S. general population who viewed photos of two male and two female physician actors, each sitting in two open and two closed postures. Photos were rank ordered after participants were asked to imagine consulting a team of anesthesiologists prior to surgery.

Examples of standard questions about body language:

• Rank physicians in order of their…
  • Confidence.
  • Intelligence.
• Rank each physician in order of how…
  • Good they seem at communicating.
  • Likely they seem to be a team player.
  • Much they seem to care for patient needs.
• Rank each physician in order of how comfortable you would feel to…
  • Ask them questions.
  • Make a decision that deviates from their recommendation.
  • Tell them about your personal preferences.
  • Discuss pros and cons of treatments with them.

Key Findings

• Male and female physicians were perceived as more professionally competent when assuming open body postures.
• Males in open postures were perceived to encourage active patient participation in doctor-patient interactions, including those supporting shared decision-making.
• Females in closed body postures were perceived as more supportive of interpersonal interactions consistent with shared decision-making.

Interpretation

This research replicates findings from at least one other study reporting that open body postures of both male and female physicians tend to communicate professional competence.(4) In addition, this study offers new information about how people view male and females differently. For example, open body postures of male doctors also communicate messages that facilitate shared decision-making. Thus, for males, avoiding closed body postures appears to facilitate communication consistent with both a professional and person-centered encounter.

For females however, closed body postures were perceived to communicate messages about shared decision-making. The reasons for these differences aren’t fully understood, though they are probably based in male/female stereotype assumptions. Nevertheless, findings from this research suggest that females who selectively use closed body postures (e.g., discussing pros and cons of care, fielding questions, understanding values and preferences) when seeking to interact in shared decision-making activities may positively influence perceptions about a willingness to engage in these activities.

Complementary Research

Prior research offers more evidence that non-verbal communication can support or negate key components of person-centered care. For example, in one study, investigators measured six etiquette behaviors performed by doctors attending patients in a hospital.(5) Of the six behaviors, physicians were most likely to introduce themselves (78%) and rarely asked patients about feelings related to their health (4%).

Etiquette-based behaviors consistent with a person-centered approach (5):

• Knocking on the door or asking to enter a patient’s room.
• Introducing themselves.
• Shaking the hand of a patient.
• Sitting in the room.
• Explaining their role in the patient’s care.
• Asking about a patient’s feelings.

None of the six behaviors occurred in 30% of patient encounters. One non-verbal behavior associated with higher patient satisfaction was simply sitting. Sitting may help improve patient satisfaction because patients tend to perceive longer visits when doctors sit.(6) The act of sitting likely implies personal concern and respect, elements of a person-centered approach.

Practical Implications

Though research on physician body language has been performed largely with other provider disciplines, the findings are most likely transferrable to chiropractors. A potential way to improve one’s approach to person-centered care is to begin with introspection, asking questions like: Does my body posture facilitate communication, or does it inadvertently create a barrier? Do I create an atmosphere so patients can feel comfortable asking questions? Do I communicate enough respect to help patients feel comfortable making decisions different from my recommendations? Do I create environments to openly discuss pros and cons of treatment so patients can make more informed choices?

Perhaps the two biggest contributions of research in this area are: 1) a reminder to regularly self-appraise communication; and 2) data to inform how to improve our capacity to engage in person-centered care.

Take-Away Messages

• Though the concepts of person-centered care are relatively simple, they are influenced by many factors, including the non-verbal communication of doctors.
• Patients tend to perceive open body positions of male doctors as communicating messages of competence and openness to person-centered interaction.
• Patients tend to perceive open body positions of female doctors as communicating professional competence, while closed postures suggest more openness to person-centered interactions.
• Doctors sometimes skip common etiquette-based behaviors that would otherwise support person-centered care.
• Practicing person-centered care is something that begins anew with each encounter.

Dr. Vining is associate dean of clinical research, as well as a professor, at the Palmer Center for Chiropractic Research, Palmer College of Chiropractic, in Davenport, Iowa. 

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References

1. Person-Centered Care | CMS Innovation Center [Internet]. [cited 2022 Nov 26]. Available from: https://innovation.cms.gov/key-concepts/person-centered-care
2. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century [Internet]. Washington (DC): National Academies Press (US); 2001 [cited 2022 Apr 5]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK222274/
3. Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med. 2012 Mar 1;366(9):780–1.
4. Forkin KT, Dunn LK, Kaperak CJ, Potter JF, Bechtel AJ, Kleiman AM, et al. Influence of Sex and Body Language on Patient Perceptions of Anesthesiologists. Anesthesiology. 2019 Feb;130(2):314–21.
5. Tackett S, Tad-y D, Rios R, Kisuule F, Wright S. Appraising the practice of etiquette-based medicine in the inpatient setting. J Gen Intern Med. 2013 Jul;28(7):908–13.
6. Swayden KJ, Anderson KK, Connelly LM, Moran JS, McMahon JK, Arnold PM. Effect of sitting vs. standing on perception of provider time at bedside: A pilot study. Patient Educ Couns. 2012;86(2):166–71.