Nonverbal Communication in the Patient Consultation

In aesthetic medicine, patient conversion can make or break the top line productivity of a practice. Ideally, the consultations that take place in your office turn inquiries into new patients, but often this is not the case. Have you ever felt that a consult did not go well, yet not understood why? While post-consultation patient surveys are a great way to capture this important information after the fact, there are ways you can effectively intervene during a consult when you feel things going awry.

You might think discerning an individual's confusion or dissatisfaction during a patient consultation is a complicated process, but it can be simpler than you think. Only eight to 10 percent of the information transmitted between two people in face-to-face communication is verbal. The other 90 percent is contained in nonverbal cues and tone of voice. In the patient consultation, most decisions are made based on “feel” and not necessarily by what is spoken.

Top 10 Cues,
During a consultation, the questions in each patient's mind are: “Does the provider understand my needs?” and “Do I feel comfortable with this provider?” Observing the nonverbal cues or indicators presented ahead can supply the clues you require to answer these unspoken questions and assure your patients and prospective patients of your expertise, understanding, and sensitivity to their needs. Integrating this information into the consult can serve as a bridge where there are gaps between what you are trying to say and what the patient may be hearing. Consider these “Top 10 Cues” as guidelines to further understanding between patients and your practice.

Rubbing the Neck
Rubbing the neck is a nonverbal sign that a person is uncomfortable with what you just said. An easy way to remember this nonverbal cue is to think of the expression, “hot under the collar.” If a patient rubs his or her neck during a consult, you may want to back off for a moment. Backing off may be as simple as sitting back in your chair and allowing the patient time to digest information and process what has been communicated. Mirroring the patient's body language at this time can be valuable. You also may choose to rephrase your original statement in order to appear softer. Asking how that person is feeling about what he or she has heard can be an effective way to gain insight into this nonverbal cue. If the patient is able to articulate what has caused the discomfort, you can address any concerns before moving forward.

Hands to Mouth or Hands to Lower Face

Covering the lower part of the face or mouth is a cue that may indicate the patient may not be quite honest. This is frequently something we see in young children who are confronted when they have done something naughty. This cue often occurs toward the end of the consult as you seek to gain commitment for surgery. A patient may be bluffing about getting services cheaper somewhere else or may say the cost is more than he or she can afford. This is your opportunity to ask more questions or probe for more information. It may be a cue for you to better communicate the value of what you do. You should not press for a decision at this time, because the patient is looking for a way out. If you proceed without first understanding the perceived barriers, you risk losing your patient completely.

Finger Behind Ear
When a patient places a finger behind the ear or rubs behind the ear, that person is letting you know he or she is interested and needs to hear more. This nonverbal cue often takes place later in the consultation and is a very important indicator. If you see this, you have been given an opening to share specificity about a product or procedure. This is the perfect time to bring out the before and- after photos and move the patient closer to a buying position. Do not spend time reiterating what you have already shared! This person is ready to move forward and you should be, too.

Hands Behind Head
A patient who places his or her hands behind the head is displaying dominance and power. This individual is letting you know the significance of the role he or she will play in the decision-making process. Sometimes it is the significant other who displays this body language during a consultation, and it is important for you to ask for input at this point: “What do you think about that approach?” or “How do you feel about this?” If you fail to read this important cue, you may not be heard thereafter.

Tension in Brow
An individual is demonstrating confusion or fear when showing tension in the brow. This nonverbal cue often is seen when a patient is worried about safety of a product or procedure. You can regard this as an excellent time to credential the physician, procedure, and product you are discussing. Having a strong understanding of safety data is important for this issue to be resolved. You may ask probing questions to better understand your patient's concerns and properly address them.

Lack of Eye Contact
The eyes are “the window to the soul,” and good eye contact is a sign of positive interaction and connection. Patients who avoid eye contact are giving you a strong message that they are feeling any number of emotions that could range from the simple to the complex: overwhelmed, anxious, intimidated, or simply distracted. As long as the patient is feeling divided, you cannot provide an effective response. However, once the underlying barrier to communication is identified, you can achieve success. How you restore equilibrium and focus to the consult must be carefully considered. You have a few moments to gain the attention and trust of this prospective patient and effectively communicate the warmth, empathy, and openness that is so important to the doctor-patient relationship. You may be able to pinpoint and take steps to ameliorate the issue by quickly reviewing conversation that immediately preceded the lost eye contact. Connectivity and focus sometimes can be restored with a shared activity, such as reviewing before and after photos. Show-and-tell is an undemanding joint activity which can serve to refocus and center the patient. Whatever strategy you employ, regaining eye contact is critical before attempting to move from consult to commitment.

Fidgeting With Hands
A patient who fidgets is often communicating anxiety or nervousness.You will want to slow things down and put the patient at ease before jumping in to an in-depth discussion about diagnosis and treatment. Offering refreshments such as tea or spring water can help them to feel “at home” in your practice. Anxiety also can be reduced by easing into the consultation with a positive conversation about an unrelated topic. You may ask, “What do you do for relaxation?” or “Have you treated yourself to something fun lately?” Avoid discussions about the weather or topics that could lead to negative feelings or that might heighten anxiety (e.g., natural disasters, politics, or religion). If you are comfortable sharing a personal anecdote or story, this is an opportune time to do so; it may go a long way toward putting the patient at ease and setting the tone for a positive interaction.

Touching or Scratching Nose
Touching or scratching the nose can be a sign that the patient doesn't like what has just been said. This signal often is seen when price is mentioned and can serve as an important reminder to you that sensitivity about price is relative to perception of value. Instead of waiting for verbal “push back,” you should proactively communicate the value your practice provides for the procedure being discussed. Communicate what differentiates your practice from other practices: safety or track record, board certification, extensive training, facility accreditation, follow-up care, or the number of procedures done per year. In the end (and before returning to price), you may ask a question, such as “Are these factors important to you?” If the patient is uncomfortable about a procedure choice, offer options that might provide similar results.

Not Facing You Directly
If a patient subconsciously turns away from you (i.e., shoulders are not parallel to yours), he or she may be communicating a lack of focus or impatience. This might be a patient that has a long buying cycle and is there to gather information rather than commit to a procedure. This person will be more comfortable with you “mirroring” them or looking at a common resource together. Seek ways to re-engage, and seize the moment to credential your practice. If you discover this individual's intention of gathering information through multiple consults, ask for a commitment to return to you for a final follow-up session when he or she has greater clarity. At that point, your prospective patient will be better informed and you will know each other better. He or she may not buy today but will soon.

Arms and Legs Crossed
A patient who crosses his or her arms and/or legs typically is feeling defensive and is communicating discomfort of some sort or somehow feels offended by the interaction. This cue can be challenging, as the person has moved to a strong negative position. It is your job to do your best to be flexible and open, yet remain committed to the best interest of the practice. Flexibility may be needed in the areas of scheduling, pricing, or promotional expiration dates. Picking up on this cue and responding appropriately can swing a patient's perception quickly. Often, your flexibility and willingness to meet the patient's needs is all it takes to secure a commitment for a procedure.

Attaining a Higher Conversion Rate
Understanding the nuances of how your patients communicate through nonverbal cues can dramatically improve your conversion rate and, in the end, your productivity. In addition, better communication will create an opportunity to enhance customer service, evaluate product services, and grow word-of-mouth advertising. With nonverbal cues in mind and a willingness to pay better attention to body language, you may be better able to create an environment where patients feel safe, comfortable, and free to discuss all aspects of their health and treatment goals. Careful response to directional cues will allow physicians, aestheticians, cosmetic coordinators, and other non-physician providers to enter consultations with more confidence to deliver what patients desire and, ultimately, to provide the basis for a long-term, healthy relationship with patients.