This study seeks to investigate the non-verbal communication strategies used by doctors in doctor-patient interactions during the initial consultation in a clinical setting. Non-verbal communication can be conceptualised as any form of communication that does not use the written or spoken word. (Birdwhistell: 1990, Melirabian: 1981).It is more than just body language since it includes, use of time, space, clothing, furniture, features of the environment (temperature, lighting) how we utter words (inflection, tone, volume) and it can occur in the absence of verbal communication through symbols and physical contexts. This study is in the broad area of interactive sociolinguistics which sees communication as the outcome of exchanges involving more than one active participant. In Zimbabwe, many complaints by patients about how doctors communicate non-verbally have being raised.
The problem which this proposed study seeks to address is: What non-verbal communication strategies are used by Zimbabwean doctors and their impact on patients? In trying to address this research problem, the study will show that although Zimbabwean doctors consciously and unconsciously send and receive non-verbal messages most of them are not fully aware of the ways they communicate. Frequently doctors verbal messages conflict with their non-verbal behaviour making patients to feel anxious and uncertain. The importance of studying doctors non-verbal communication behaviour derives from the importance of non-verbal communication strategies to negative and positive outcomes of a medical consultation such as, recovery or illness, patient satisfaction or dissatisfaction, patient understanding or anxiety, accurate diagnosis, non compliance to treatment regime, litigation and the enormous costs of health care and the impact of these costs on the national economy.
The failure to manipulate non-verbal communication strategies also leads to the use of non-traditional healthcare providers such as traditional healers ,acupuncturists, hypnotists and message therapists all of who are often perceived as more interested in the patient as a person. Due to the significant role that non-verbal behaviours play in doctor-patient interaction and the associations between physicians’ non-verbal behaviour and clinical outcomes it is important that doctors become aware of their voluntary and non-voluntary non-verbal behaviours so that they can manipulate them for positive clinical outcomes and minimise sending negative non-verbal cues. The quality of medical care rendered by a doctor depends on his knowledge, skill and medical equipment but the results achieved by a doctor in terms of success in both diagnosis and treatment are directly dependent upon his ability to communicate with his patients. In studying doctor-patient communication researchers have paid relatively more attention to verbal than non-verbal cues. As a consequence non-verbal communication has been seen as part of verbal communication since it validates verbal communication.
In this regard this research will show that non-verbal strategies are different from verbal strategies because they serve different functions hence the need to be studied separately. Researchers have also come up with a number of different coding tools for verbal strategies (eg: Process Analysis system, Roter Interaction Analysis, The Verbal Response mode) while a few exist for non-verbal strategies (e.g.: Relational communication Scale). Non-verbal cues have been shown to have a universal meaning depending on the context and because of this contextual dependency there is no precise interpretation of non-verbal behaviour and our understanding of what specific doctors non-verbal cues signify remain scattered. Therefore this investigation is worth undertaking because it seeks to identify the non-verbal strategies used by doctors in Zimbabwe and how patients of a “Zimbabwean” culture derive meaning by relating them contexts in which interactions occur. OBJECTIVES
This study aims to:
● Identify the non-verbal communication strategies used by doctors in doctor-patient interaction during the initial consultation.
● Establish the effect of non-verbal communication strategies on Patient satisfaction and dissatisfaction with the consultation.
● Establish the contribution of non-verbal communication on the patients understanding of the doctors’ message.
This study is significant in a number of ways. Positive Non-verbal communication strategies have been discovered to correlate with positive outcomes such as, patient satisfaction with health care, compliance with medication and positive treatment outcomes while negative non-verbal behaviours of doctors have been found to relate to decreased patients physical and cognitive functioning. Thus the choice of doctor-patient interaction as a viable area for research is by no means accidental since the research aims to make a contribution towards effective health communication in Zimbabwe by making doctors aware of non-verbal behaviours which hinder or facilitate positive medical outcomes. I have set out in this research to focus on the initial consultation because it is the first process towards healing since communication is in itself therauptic. The initial consultation is an important social occasion because this is when the doctor makes the diagnosis; outlines a plan of treatment and the patient can ask a host of questions and can have his worries addressed.
The initial consultation also has an impact on the patients’ perceptions of subsequent consultations and further interactions between a doctor and patient. .The issues discussed in this research are relevant between a patient and a doctor during the initial consultation, not because activities outside the consultation are of lesser importance but because they are informed by the consultation. This research has also been motivated by observations i made as a communication skills Lecturer in the Faculty of medicine at the University of Zimbabwe where i observed that medical students tend to concentrate on learning verbal communication skills while relegating non-verbal skills. The researcher hopes that the research will be an invaluable contribution not only to the field of doctor-patient interaction but also to the field of applied linguistics where it is becoming increasingly important to look at communication in the workplace so as to meet the needs of a world that is becoming globalised. METHODOLOGY
The primary sources of data in this research are audio-taped and video-taped doctor-patient interactions which will be used to evaluate the actual medical encounter since patients may have greater impact on their own outcomes than the doctor’s and non-verbal behaviour since these perceptions are subjective to bias depending on factors such as, patient health status and status of mind which might not actually reflect the reality of the consultation. Formal and informal interviews and questionnaires will also be used to gather data on patient satisfaction with the medical interview .since some patients are sensitive about their health and may refuse to co-operate or might not self disclose to a doctor in the presence of an observer. The research will be conducted at Parirenyatwa Group of Hospitals and the researcher has been granted permission by the Clinical Director to conduct the research on the condition that the anonymity of patients and doctors and that the professional integrity of doctors will be preserved.
To cater for ethical considerations the research will be conducted in a conscientious manner. The researcher will seek consent from all the participants and participation will be voluntary. No one other than the researcher will have access to raw data and real names will be excluded from the recordings. The researcher is aware that the quality of data can be affected by the data collection process itself since the presence of recording equipment and the process of gaining consent mean that there is a heightened awareness of being observed. Several strategies will be used to reduce the potential of the ‘observer’s paradox ‘such as the use of discreet recording equipment and self recording so that there is no need for a third part to be present with the sole purpose of collecting data.
The recorded and observed interactions will be coded following the rules of coding interactions and then analysed .A detailed transcription which is inductive driven will be used to identify recurring patterns of interaction and from this the researcher will be able to identify the doctors non-verbal communication strategies. Quantitative and qualitative methods will be used to characterise patient satisfaction with the medical interviews. An ethnographical analysis of the interactions will permit the understanding of the interview from a functional role while a conversational analysis framework allows analysis of interactions beyond the sentence level that is into the social and cultural context. LITERATURE REVIEW
Medical literature contains a large number of research studies that have evaluated doctor –patient interactions and documented the desirable and undesirable results of such interactions (Gordon: 1995, Korsh and Negrete: 1972).Birdwhistel (1968) researched on non-verbal communication in a consultation and concluded that non-verbal cues were much more effective than verbal messages. Opinions seem to be coalescing around severally commonly accepted positions. The first of these attests to the pivotal role of non-verbal communication strategies of doctors in influencing patient’s experiences in clinical settings(Ong et al :1995).According to Ong et al (1995)7% of affective communication in health is verbal, while 22% is conveyed by tone of voice and 55% is conveyed by visual cues. Despite this fact various studies have shown how doctors value their verbal and technical skills when interacting with patients and how they relegate non-verbal skills leading to negative outcomes of interviews. (Simpson et al: 1991, Maguire: 1974).
A systematic review of studies on non-verbal communication used by doctors reveal that non-verbal communication strategies can actually influence the patients course of recovery, patients satisfaction with health care, adherence to treatment regime, self disclosure and subsequent visits by patient since supportive communication can decrease the patients anxiety which is the basic concomitant of illness(DiMatteo and Toraita:1979) .Whilst non-verbal communication has been shown to exist in isolation at times it has been shown to validate verbal messages,mitigate,and contradict verbal communication. Researchers seem to agree that in many instances doctors verbal messages contradict their non-verbal cues and this has been shown to increase patients anxiety(Flores:2005,Hall et al: 2005).When there is a mismatch between verbal and non-verbal communication ,patients have been shown to regard the non-verbal communication as being reflective of the doctors state of mind(Ambady 2002).
In doctor-patient interaction a number of non-verbal cues have been identified and linked to positive and negative health outcomes. Facial expressions such as gaze ,frown, eye dilation and positions of the mouth were correlated to distancing behaviour of doctors and increased disclosure of patients psychosocial information (Mehrabian;1972).Body posture ,body proximity, open arms and touch were also linked to an overall degree of closeness and patients understanding(Hall: 1973,Smith:1981). Numerous studies also show that patients were found to be less satisfied when doctors dominated the interviews by interrupting patients or when the emotional tone was charactised by doctors’ dominance. Such high control styles on medical problems have been shown to inhibit patients from expressing their ideas and spontaneously bringing them up (Bertakis :1991).With regards to the sociolinguistic structure of communication doctors were often found to adopt a style of high control which involved doctor initiated questions ,interruptions and neglect of patients feelings and world view.
Communication descriptions by patients in such instances included the following adjectives :rude,aggressive,abrupt,authoritative,cold and uninterested. Non-verbal skills such as ,open body posture ,facial expressions,smile,eye,gaze,head nods, postural position and paralinguistic speech characteristics such as, speech acts ,intonation, pitch and speech disfluences were found to be more effective in influencing patients course of discovery (Dimatteo :1979).Doctors with better paralinguistic skills were shown to be less likely to be exposed to malpractice litigation because dominance coupled with the lack of anxiety in the voice implied doctors indifference and detachment. Female and Male doctors have also been shown to communicate differently.
Female doctors were shown to exhibit more supportive behaviours than male doctors and they were also shown to be able to adjust their status to equal that of the patients thereby making patients to self disclose. The studies cited in this discussion will in different ways contribute immensely to the development of this study. The studies cited in this discussion will in different ways contribute immensely to the development of this study.
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