Thursday, 4 March 2010

Body Language

We are taught at medical school of the importance of communication, verbal and non-verbal. We are shown how to arrange a consulting room to best nurture the doctor-patient relationship, advised on what to wear (mini skirts out, sensible frocks in) and made to watch ourselves on video to see how we perform. It forms part of the new 'touchy-feely' approach to teaching medical students and whilst I acknowedge its importance, I don't think many of us took it very seriously at the time. I always believed that either you found it easy or you didn't.

Nowhere are communication skills taken more seriously than in GP training. You attend courses, (pretend to) read books on the subject, and swot up on models and theories put forward by learned professors who have dedicated a lifetime to consultation analysis. But here again, I couldn't help thinking that most of it was a waste of time and effort. I learnt a few useful tricks, but on the whole, I felt that I was lucky enough to find talking to patients pretty easy, with or without the help of Roger Neighbour et al.

I have learnt not to be so smug.

On Monday afternoon I met Mr Hussain. He turned up for the first appointment after lunch, ten minutes late. That made me cross. As a result when I called him in, I failed to give him my welcoming smile and left out the usual pleasantries. Instead I ushered him in to sit, and asked, in a fairly cool manner, how I could help.
"Oh" he said, "I was hoping to see Dr Jones."

I could feel the hackles go up. My initial mild irritation intensified as I explained that Dr Jones was not in today. I emphasized that I would be happy to make him an appointment with Dr Jones the next day if he would rather. More than happy.

There was a long pause during which Mr Hussain simply stared at me. More annoying still. But then I saw something in his eyes that I hadn't noticed before. He looked anxious and timid. I realised that in his silence he was weighing up whether or not he could confide in me, looking for the smallest sign from me to proceed. I felt ashamed of myself. I uncrossed my arms, sat forward in my chair, and met his gaze. It was enough.
"It's man trouble" he said.


So I've been taught a valuable lesson. In being complacent about my perceived aptitude as a communicator, I have missed the fact that with this comes the danger of complete transparency. In essence, my communication can be a little too effective. I run the risk of communicating hostility as well as kindness, impatience as well as patience, apathy as well as sympathy.

My challenge therefore is not to communicate what I'm feeling. Not to let Mrs Smith know that I'm miserable because I've given up wine for lent; not to let Mr Jenkins see how distracted I am by his comb over; not to make Mr Hussain feel uncomfortable purely because I'm annoyed that he's late.

Perhaps a gentle word of warning then to those who believe, as I did, that they are born communicators. For you may be giving away rather more of yourself than you'd wish...


  1. Thank you! This is a wonderful account and reflection and MAKES A LOT OF SENSE!

    I will be sharing this widely.

  2. An excellent and thoughtful post. But - isn't your penultimate paragraph pure Roger Neighbour/Inner Game stuff?

  3. Perhaps I took something in after all?