From job interviews to first dates and conversations with our friends, we know how important eye contact is for making a positive impression. The same goes for doctor’s visits—making meaningful eye contact is a crucial skill for doctors to help show empathy and make patients feel that they understand and care about their needs.
Positive feelings are one thing. But does eye contact make any difference in clinical outcomes for patients?
Rita Gorawara-Bhat, PhD, senior staff scientist in the Section of Geriatrics and Palliative Medicine, researches the ways both verbal and nonverbal communication between physicians and elderly patients can affect care. In a new study, she and her colleagues watched hundreds of hours of videotapes of doctors interacting with patients and found that eye contact, especially when it’s matched with meaningful verbal communication, does indeed help patients understand what the doctor is telling them and helps them stick to their treatment plans.
Gorawara-Bhat said that nonverbal communication, such as eye contact and touch, is especially important when treating elderly patients.“There are many difficulties that physicians have in communicating with older patients because of their frailty, hearing and vision difficulties, alongside all the comorbidities that an older patient may come along with at that age,” she said.
This is the latest in a series of studies, in which she and her colleagues have focused on how doctors can communicate better with elderly patients. They began in 2007 by looking at how the physical setup of an exam room affects doctor-patient communication. In 2011 they studied how eye contact facilitates “patient-centered” communication, or where the conversation is focused on the patient as a person, not just a customer who happens to have some ailment or disease.
In the latest study, published in the journal Patient Education and Counseling, Gorawara-Bhat and her colleagues studied archived videotapes from the National Institute of Aging of elderly patient visiting physicians. They analyzed the history-taking portion of the visit, where the doctor asks about how the patient is feeling, what medications they’re taking etc., because this tends to be the part of the visit where the patient speaks the most. They used qualitative software to analyze the amount of verbal communication by the physician and patient, and then scored each tape for levels of nonverbal interaction, including eye contact.
The researchers matched this data with questionnaires from the patients about how much they understood from the visit, and whether or not they followed the doctor’s orders for taking medication and follow up care. They found that eye contact alone didn’t improve patients’ understanding or adherence. The quality of eye contact also didn’t affect understanding and adherence differently during different types of visits, whether routine and those about more serious illnesses such as cancer.
Gorawara-Bhat said that physician eye contact is most effective when it is accompanied by appropriate verbal cues and attention, what the researchers call “verbal synchronicity.” This crucial combination of verbal and nonverbal communication can also be thought of as “looking, listening and talking.” It creates a feeling that the doctor is paying attention, not just hearing what the patient is saying while they scribble on their chart, or more appropriately in this day and age, type notes into their electronic medical record. Even if the physician makes a point to occasionally glance up from what they’re doing, patients are highly sensitive to whether or not they feel the doctor is paying attention. This is an important component of care for the elderly.
“Older patients often go to a physician, not for that prescriptive solution for their ailment, but for their affective climate. They are looking for somebody to understand them, talk to them and communicate with them,” Gorawara-Bhat said. “It’s a social event for the patient.”
She said that understanding how these nonverbal cues affect this dynamic is becoming more important with an aging patient population.
“These are patients who rely on the nonverbal dimensions of communications of which eye contact is a crucial component,” she said. “This is where physicians can make a real difference in healing their patients.”
Gorawara-Bhat R, Dethmers DL, & Cook MA (2013). Physician eye contact and elder patient perceptions of understanding and adherence. Patient education and counseling PMID: 23537851