The Utility of Assessing Nonverbal Communication in the Psychiatric Evaluation

Abstract

You see, but you do not observe," begins Sherlock Holmes in the 1891 short story A Scandal in Bohemia, by Arthur Conan Doyle. The passage that follows illustrates the idea of mindful observation, as Holmes makes a point to distinguish it from just seeing the steps that lead up to the room in which he and Watson stand (1). In fact, this concept of active observation is integral to the practice of medicine. As William Osler said, "the whole art of medicine is in observation" (2). Physicians perform evaluations based on the patient's communication of ailments. Oxford Dictionary defines communication as "the imparting or exchanging of information" (3). This exchange can take many forms when interacting with a patient. Most commonly what physicians conceptualize as communication is that which is spoken by the patient. However, literature continues to reveal the importance of nonverbal behaviors in communication. THE STUDY OF NONVERBAL COMMUNICATION All forms of communication other than words can be considered nonverbal communication (4), including vocal tone, facial expressions, posturing, and bodily movements. In his 1882 book, The Expression of the Emotions in Man and Animals, Charles Darwin put forth the idea of bodily movements representing internal emotional states as a result of evolution and inheritance. He argued that these movements we see accompany certain emotional states are universal to our species and that they serve a purpose while in that emotional state (5). This was demonstrated by his understanding of the function of these

Can doctors improve the patient experience by rearranging the furniture and equipment in their office? A video recorded simulation

“…Attention to the non-verbal communication in the consultation is important in achieving better outcomes in medicine. 10 There is evidence from this experiment that it may be better for patients to occupy an appreciably larger chair in the consultation. This is associated with greater enablement and more positive engagement with the doctor.…”