Nonverbal - that is, without words. These are gestures, facial expressions, postures, touches, facial expressions, etc. This channel of communication is less controllable by the mind. An observant caregiver can notice this and correct the situation.
For example, a patient, agreeing to a particular procedure, says out loud: “Do it quickly, I’m ready!”, and the expression on his face shows: “This can be dangerous. I’m very afraid!” You can explain the procedure again with an encouraging smile, and the level of fear will decrease. Sometimes the whole human body is involved in nonverbal communication - arms, abdominal muscles, sweating, etc.
The nurse must learn to understand non-verbal messages - after all, not every patient can use oral speech as a way of communication. And nonverbal communication begins to play a leading role.
- Walking is a very communicative method of communication. A fast, nervous gait means a feeling of anger. A confident walk is a demonstration of well-being. A slow gait is an expression of fear and anxiety. In addition, sometimes the gait indicates a patient’s illness (a stiff gait is a sign Alzheimer's disease ).
- Hand movements. Hands not only comment on the reported verbal information, but also indicate a certain emotional state. Let's say, twisting an object, sweeping movements indicate anxiety, frustration, anger. Wringing your fingers or squeezing your hands and pressing them tightly to your chest is a sign of strong excitement and frustration. Hand trembling is either strong excitement or an indication of Parkinson's disease . Uncoordinated movements (the patient tries, but cannot get his finger into, say, the bell button) should cause alarm - these may be harbingers stroke .
- Facial expression. The nurse must ensure that her face always remains friendly, not frowning, not pursing her lips. Displeasure can be expressed more softly: wag your finger and shake your head. Patients watch very carefully the facial expressions of those who treat and care for them. Therefore, you need to do everything to relieve his tension, fear, and stress.
- The most important channel of nonverbal communication is the eyes. You should not take your eyes away from the patient, hide them, or raise them up. In some cases, an expressive look can convey the meaning not only of what was said, but also of what was not intended to be communicated to the patient, as well as radically change the meaning of the transmitted message. Especially when it comes to answering questions about the prognosis of the disease, the severity of the condition, the danger of a particular symptom. Therefore, the nurse must monitor the expression of her eyes (you can mentally say to yourself, “What a nice person,” even if this is not entirely true).
- Appearance. An unkemptly dressed, unpleasantly smelling, poorly combed nurse evokes negative emotions in the patient, and this greatly complicates communication. On the contrary, a neat, fresh-looking, friendly, positive-minded nurse can increase the patient’s vitality and give him strength.
Reasons for mutual misunderstanding
There are often cases when, despite the presence of all five elements of communication (from the sender of information to confirmation of its receipt), the patient does not fully understand what is being said to him.What are the reasons for this?
1. Either the person transmitting the information or the recipient does not have sufficient knowledge of the language spoken by the sender or speaks with a noticeable accent.
2. The sender speaks too quickly or too quietly, unclearly or without thinking through the message in advance.
11.07.2016
Few people pay attention to the important role nonverbal communication between doctor and patient plays. Meanwhile, a person perceives only 23% of information by ear, the remaining 77% he receives through visualization of an object.
If these numbers seem unconvincing to you, I suggest you conduct a small experiment. Remember your student years and everything connected with this period. Including their teachers. Surely among them there was a bright personality, a teacher with a capital T, whose lectures you tried not to miss. But the manner in which another lecturer presented the material gave you only one desire - to sleep. Do you remember? And now - attention, question. What did both teachers talk about during the very first class? And on the last one? God grant that you remember at least the name of the subject and the general essence of the lectures. But we remember gestures, manner of speaking, laughing, timbre of voice and, in general, the entire appearance quite clearly.
This little excursion into your student past clearly demonstrates how poorly we remember what What they tell us. At the same time, memory retains for a long time what How they tell us this. That is, nonverbal communication is more informative than verbal communication.
Nonverbal communication (“body language”) - this is a communication wordless interaction between people (transfer of information or influence on each other) through intonation, gestures, changes in the mise-en-scène of communication, that is, without speech and language means presented in direct or any sign form. The instrument of such communication is the human body, which has a wide range of means and methods of transmitting or exchanging information.
The ability to “read” gestures and facial expressions is one of the most important skills of a doctor in communication not only with patients, but also in ordinary everyday practice. Unfortunately, people who do not have this skill will be able to successfully interpret nonverbal communication methods only 50% of the time. In other words - guessed/wrong. And being able to “read” the facial expression of your interlocutor means being able to correctly build a dialogue with him.
To date, a considerable number of scientific works have been published (mainly in the USA and Western European countries) on the topic of non-verbal behavior of patients and the doctor’s ability to understand the psychological aspects of patients’ emotions, etc. They have begun to pay more attention to this problem in our country.
In this case, we are interested in the practical side of nonverbal communication between the doctor and the patient. But before we get into it, we need to add a few comments:
- Human gestures and facial expressions are a physiological reaction to an external stimulus. In other words, if you see/read/hear/remember something that you think is funny, you will definitely smile at least for a split second.
- Nonverbal communication can be considered as a kind of international method, the same for all nations, ages, languages and cultures. Because people in all countries express joy, sadness, pain, disgust, admiration, etc. in the same way.
- Controlling your nonverbal behavior is extremely difficult; it requires many years of professional training (for example, in law enforcement agencies, agents spend years learning “body language” and controlling their emotions).
Over the several years of the existence of the “Academy of Successful Doctor” project, we often have to deal with the fact that a doctor, who has only 12 minutes at his disposal to examine each patient and fill out a medical card, simply does not have the opportunity to pay attention to studying facial expressions, poses, or options behavior of your patient.
For example, the patient sits with his legs and arms crossed - the so-called “closed pose”. It would seem that it is familiar to many, and few doctors pay attention to it. But in vain. It serves as a kind of signal - the patient is experiencing discomfort. This is a signal for the patient if he sees a doctor in front of him in the same position.
It also happens that the patient squeezes his shoulders from time to time during a conversation or examination. This suggests that he either feels insecure or doubts what the doctor is telling him. This, again, can be ignored, but if the doctor wants to achieve success in treatment, he needs to earn the patient’s trust, at least in order to increase his compliance with the prescribed therapy. This largely ensures the achievement of a favorable result, which means it will serve as proof for the doctor of his success as a specialist. That is, the patient’s trust and favor are almost half the success. Otherwise, very unpleasant situations may arise. Let's look at them.
During an examination or taking an anamnesis, the patient frowns, looks from under his brows, clenches his fists tightly, sticking out his index finger, curls his lips - in a word, with his whole appearance he shows that he is set up for a conflict.
Unfortunately, as a rule, the doctor prefers to pretend that he does not notice the patient’s aggressive attitude, and sometimes, what is even worse, he “accepts the challenge” and begins to behave demonstratively rudely in response. Of course, in such cases there is no need to talk about any trust between the doctor and the patient, there is nothing to hope for any success in treatment, and therefore, no one would think of calling such a doctor successful. And all only because he did not consider it necessary for himself to learn how to correctly interpret nonverbal methods of communication.
So why should a doctor pay so much attention to nonverbalism? The answer is simple - this will allow him to spend less time talking during the examination, seize the initiative in time, overcome objections, prevent conflicts and establish long-term trusting relationships with the patient.
Let's consider another situation. After a routine examination of an infant, the pediatrician, giving various kinds of instructions to young parents, abundantly uses in his speech not always clear medical terms to refer to even the most ordinary things. But what is routine for a doctor, is a complete dark forest for ordinary moms and dads. Parents, instead of remembering the appointments, begin to blink in confusion, look at each other, wrinkle their foreheads, trying to understand whether they mean the same thing as the doctor, and as a result they begin to ask a lot of questions. But if the doctor paid attention in time to the non-verbal language of his counterparts, he would begin to use words that are more understandable to a non-specialist, which would give him the opportunity to reduce the appointment time, and this is very important when your patient is an infant.
Some advice to a doctor who wants to learn how to recognize a patient’s nonverbal manifestations, but does not have the time or opportunity to undergo training in this skill:
- Try to determine norm your patient's behavior. Is he calm during communication or, on the contrary, is he too active or even nervous, sociable or taciturn, is he characterized by active gestures, or is he stingy in his movements? This will become your starting point for further dialogue.
- When communicating with a patient, try to look at him and not at documents, a computer, etc. That is, show interest and attention.
- If there is any deviation from the norm in the patient’s behavior, do not bother trying to interpret these deviations. You do not have time for this and, most likely, do not have enough experience and special knowledge.
- If you notice a deviation from the norm, ask the patient a question. For example: during the consultation he behaves calmly, but at the end he begins to speak faster and gesticulate more. Why did he begin to behave this way? There can be 1000 reasons and only one! It is best to ask a clarifying question: “is everything clear to you?”, “do you have any questions?”, “can I be of assistance to you in anything else?” We assure you that the patient will be grateful to you for your attentiveness.
- Remember, a patient may have a lot of reasons for this or that gesture or this or that position! During a normal, friendly conversation with you, he suddenly crossed his arms over his chest. What could be the reasons? He may have a stomach ache or suddenly feel cold. Perhaps he is shivering. But it is also possible that he doesn’t understand something, etc.
- To have a good understanding of nonverbal communication, it is not enough to simply ask leading questions to your patients. If you really want to understand what is hidden behind a particular gesture, try copying it! The human body is an amazing mechanism. Any of our sensations, feelings, any of our emotions will receive its non-verbal embodiment - in a gesture, grimace or pose. Most often they are quite easy to read, because almost everyone has the same ones. After all, we are unlikely to confuse a grimace of disgust with a joyful and happy facial expression. Therefore, to figure out what your patient was thinking about during his last visit to you, when he was looking somewhere over your head and impatiently tapping his fingertips on the table, reproduce all this at home, in front of the mirror. And when you see your face, you will understand that the patient does not consider you a major specialist in your field, and therefore will be skeptical about your prescriptions.
A successful doctor must be able to read the patient’s non-verbal language in order to respond adequately and in a timely manner to its changes. This will simplify the relationship with the patient, allow you to establish a trusting relationship with him, save time, prevent conflicts and will directly contribute to the transfer of the patient from the “patient” category to the “client” category.
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Communication is a complex, multifaceted process of establishing and developing contacts between people, generated by the needs of joint activities and including: exchange of information, development of a unified interaction strategy, perception and understanding of another person.
There are three levels of communication.
Intrapersonal – mental communication of a person with himself, when he develops some plans, develops ideas, prepares to communicate with someone, etc.
Interpersonal – communication between two or more people.
Public – communication between a person and a large audience.
The person who addresses information to another person (communicator), and the one who receives it (recipient).
Parties of communication:
Communicative (transfer of information). Communication includes the exchange of information between participants in joint activities, which can be characterized as the communicative side of communication. When communicating, people turn to language as one of the most important means of communication.
Interactive (interaction). Exchange in the process of speech not only words, but also actions and deeds. When making a payment at a department store cash register, the buyer and seller communicate even if neither of them says a word: the buyer hands the cashier a sales receipt for the selected purchase and money, the seller knocks out the receipt and counts out the change.
Perceptual (mutual perception). It is very important, for example, whether one of the communication partners perceives the other as trustworthy, intelligent, understanding, prepared, or whether he assumes in advance that he will not understand anything and will not understand anything communicated to him.
There is unity of joint activity and communication. In joint activities, a person must, if necessary, unite with other people, communicate with them, establish contact, achieve mutual understanding, receive the necessary information, provide feedback, etc. In this case, communication acts as a side, part of the activity, as its most important informative aspect as communication (communication of the first kind).
In communication, a person constantly learns to separate the essential from the inessential, the necessary from the accidental, to move from images of individual objects to a stable reflection of their general properties in the meaning of words. In communication, essential features are fixed that are inherent in a whole class of objects and thereby relate to the specific object in question. For example. When we say “newspaper,” we mean not only the sheet of newspaper that we hold in our hands, but we thereby indicate which class of objects this item belongs to, taking into account its differences from other printed materials, etc.
To achieve the goals of communication and joint activity, we must use the same system of codification and decodification of meanings, that is, speak “the same language.”
If the communicator and the recipient use different codification systems, then they cannot achieve mutual understanding and success in joint activities.
The biblical story about the construction of the Tower of Babel, which failed due to the unexpected “confusion of languages” of the builders, reflects the fact that interaction is impossible when the processes of codification and decodification are blocked, since people speaking different languages cannot agree with each other, which makes joint activity impossible.
The exchange of information becomes possible if the meanings assigned to the signs used (words, gestures, hieroglyphs, etc.) are known to the persons participating in the communication.
Meaning is the content side of a sign as an element that mediates knowledge of the surrounding reality. Just as a tool mediates the labor activity of people, signs mediate their cognitive activity and communication.
To convey meaningful information to each other, people began to use articulate sounds, to which certain meanings were assigned. It was convenient to use articulate sounds for communication, especially in cases where the hands were occupied with objects and tools, and the eyes were turned to them. The transmission of thoughts through sounds was convenient even at a considerable distance between those communicating, as well as in the dark, in fog, in thickets. Thanks to communication through language, the reflection of the world in the brain of an individual person is constantly replenished with what is reflected or has been reflected in the brains of other people, thoughts are exchanged, information is transferred.
Speech is verbal communication. Words can be spoken aloud, silently, written, or replaced by deaf people with special gestures that act as carriers of meaning. The so-called dactylology, where each letter is indicated by finger movements, and sign language, where a gesture replaces an entire word or group.
The emotional attitude that accompanies a verbal utterance forms a special, nonverbal aspect of the exchange of information, a special, nonverbal communication.
The means of non-verbal communication include gestures, facial expressions, intonation, pauses, posture, laughter, tears, etc., which form a sign system that complements and enhances, and sometimes replaces the means of verbal communication - words.
For example, to a friend who has told about the grief that has befallen him, the interlocutor expresses his sympathy with words accompanied by signs of nonverbal communication: a saddened expression on his face, a lowering of his voice, pressing his hand to his cheek and shaking his head, deep sighs, etc.
Facial expressions do not always convey what a person is saying. Sometimes the whole body is involved in transmitting information, such as a person's gait. She can demonstrate well-being, anger, or, conversely, restraint and fear. You can get a lot of information from facial expressions, facial expressions, and gestures. A person’s gaze complements what is not said in words, gestures, and often it is the gaze that gives the true meaning to the spoken phrase; in addition, an expressive gaze is able to convey the meaning of not only what is said, but what is unsaid or unspoken. In some cases, you can say more with a look than with words. Hands play an important role in sign language; hands can also convey an emotional state.
Means of nonverbal communication are the same product of social development as the language of words, and may not be the same in different national cultures. For example, Bulgarians express disagreement with their interlocutor with a nod of the head, which a Russian perceives as approval and agreement, and a negative shake of the head, common among Russians, can easily be taken by Bulgarians as a sign of agreement.
In different age groups, different means are chosen for non-verbal communication. Thus, children often use crying as a means of influencing adults and as a way of conveying their desires and moods to them. The spatial placement of the communicators is essential for enhancing the effect of verbal communication. For example, a remark thrown over the shoulder clearly shows the communicator’s attitude towards the recipient.
Verbal and nonverbal communication can exist simultaneously. For example, communication occurs in the form of a conversation, it can be accompanied by a smile, gestures, crying, etc. In general, the perception of a message largely depends on non-verbal communication.
Communication as interpersonal interaction is a set of connections and mutual influences of people that develop in the process of their joint activities.
When entering into communication, that is, turning to someone with a question, request, order, explaining or describing something, people necessarily set themselves the goal of influencing another person, getting the desired answer from him, fulfilling an order, understanding something he didn't understand until then.
The goals of communication reflect the needs of joint activities of people. This does not exclude cases of empty chatter, that is, phatic communication - the meaningless use of communication means for the sole purpose of maintaining the communication process itself. If communication is not phatic, it necessarily has or, in any case, presupposes some result - a change in the behavior and activities of other people. Interpersonal interaction is a sequence of people’s reactions to each other’s actions unfolded over time.
Social norms play a large role in interpersonal interaction. The range of social norms is extremely wide - from patterns of behavior that meet the requirements of labor discipline, military duty and patriotism, to rules of politeness. People's appeal to social norms makes them responsible for their behavior, allows them to regulate actions and actions, assessing them as consistent or inconsistent with these norms. Orientation to norms allows a person to correlate the forms of his behavior with standards, select the necessary, socially approved ones and weed out unacceptable ones, direct and regulate his relationships with other people. Learned norms are used by people as criteria by which to compare their own and others' behavior.
A social role is a relatively stable pattern of behavior developed in a given society to perform a certain objective social function, to realize a certain social status. Let's say, the subject acts as a teacher or student, doctor or patient, adult or child, boss or subordinate, mother or grandmother, man or woman, guest or host, etc. And each role must meet very specific requirements and certain expectations of others .
Social status is a set of rights and responsibilities of a person determined by his position in a certain social system and hierarchy of social relations.
Social status answers the question “Who is he?”, for example, psychologist, engineer, doctor, military man, and role – “What does he do?”, what socially typical aspects of behavior does he exhibit?
Social status is associated with a system of social expectations, that is, a person is expected to act in certain ways, and he expects others to treat him or her in a certain way. Some social expectations are expressed in clear rules and instructions, while others are sometimes simply not realized. If a person’s behavior diverges from social expectations, if he poorly fulfills his social role, then the social group and people around him apply social sanctions and coercive measures to him, say, ridicule, reprimand, threats, disapproval, boycott, etc.
Social roles and role connections are carried out in accordance with the repertoire of roles “performed” by communicating people. The same person, as a rule, performs different roles when entering different communication situations.
The way the role is performed is subject to social control, necessarily receives public assessment, and any significant deviation from the model is condemned. For example, parents should be kind, affectionate, and lenient towards children’s misdeeds - this meets role expectations and is socially approved, recognized as worthy of all encouragement. But an excess of parental affection and forgiveness is noticed by others and is strongly condemned. There is a certain range within which playing the role of mother is seen as socially acceptable. The same applies to other family members belonging to the older generation. As for the child, role expectations are associated with mandatory obedience, respect for elders, excellent academic performance, neatness, diligence, etc.
A necessary condition for the success of the communication process is that the behavior of interacting people matches each other’s expectations.
Each person, entering into communication, more or less accurately attributes to the people treating him certain expectations regarding his behavior, words and actions. If a situation arises in which the subject’s principles and beliefs come into sharp conflict with what he understands others expect from him, he, while showing integrity, may not care about how tactful his behavior is.
Friendly communication. Friendly communication is a special form of communication between people. Friendship is a stable individual-selective system of relationships and interactions, characterized by mutual affection of those communicating, a high degree of satisfaction with communication with each other, mutual expectations of reciprocal feelings and preference.
The problem of finding companionship and a friend becomes especially relevant in adolescence. For example, adolescents face real difficulties in weighing the true nature of their relationships against the standard of the friendship code. Sometimes disappointments when identifying the inconsistency of the developing relationship with the ideal of friendship give rise to quarrels.
Communication becomes possible only if people interacting can assess the level of mutual understanding and understand what a communication partner is like. Participants in communication strive to reconstruct each other’s inner world in their minds, to understand feelings, motives of behavior, and attitudes towards significant objects.
The subject is directly given only the external appearance of other people, their behavior and actions, and the means of communication they use. He has to do some work in order, based on this data, to understand what the people with whom he came into contact are, to draw a conclusion about their abilities, thoughts, intentions, etc.
S. L. Rubinstein wrote: “In everyday life, when communicating with people, we are guided by their behavior, since we seem to “read”, that is, decipher the meaning of their external data and reveal the meaning of the resulting text in a context that has an internal psychological plan. This “reading” proceeds fluently, since in the process of communicating with others we develop a certain more or less automatically functioning psychological subtext to their behavior.”
Identification is a way of understanding another person through conscious or unconscious assimilation of his characteristics to the characteristics of the subject himself.
In interactional situations, people make assumptions about the internal state, intentions, thoughts, motives and feelings of another person based on an attempt to put themselves in their place.
Reflection is the subject’s awareness of how he is perceived by his communication partner.
Reflection is part of the perception of another person. To understand another means, in particular, to understand his attitude towards himself as a subject of perception. The perception of a person by a person can be likened to a double mirror image. A person, reflecting another, reflects himself in the mirror of the perception of this other.
In communication processes, identification and reflection appear in unity. If every person always had complete, scientifically based information about the people with whom he came into contact, then he could build tactics for interacting with them with unerring accuracy. However, in everyday life, the subject, as a rule, does not have such accurate information, which forces him to attribute to others the reasons for their actions and actions.
A causal explanation of the actions of another person by attributing to him feelings, intentions, thoughts and motives of behavior is called causal attribution or causal interpretation.
For example, a nurse’s erroneous causal interpretation of a patient’s actions makes normal interaction difficult and sometimes even impossible.
Causal attribution is most often carried out unconsciously - or on the basis of identification with another person, that is, when attributing to another person those motives or feelings that the subject himself, as he believes, would have discovered in a similar situation. Or by assigning a communication partner to a certain category of persons, in relation to which certain stereotypical ideas have been developed.
Stereotyping is the classification of forms of behavior and interpretation (sometimes without any basis) of their causes by attributing them to already known or seemingly known phenomena, i.e., corresponding to social stereotypes.
A stereotype is a formed image of a person that is used as a cliche.
Stereotyping can develop as a result of a generalization of the personal experience of the subject of interpersonal perception, to which is added information obtained from books, films, etc., remembered statements of acquaintances. Moreover, this knowledge can be not only questionable, but also completely erroneous; along with correct conclusions, it can turn out to be deeply incorrect. Meanwhile, the stereotypes of interpersonal perception formed on their basis are often used as supposedly verified standards for understanding other people.
The inclusion of interpersonal perception in the process of joint socially valuable activity changes its nature, makes causal attribution adequate, and eliminates the negative effect of the halo effect.
Communication necessarily involves reflection. Based on this information, he continuously adjusts his behavior, rebuilding the system of his actions and means of verbal communication in order to be correctly understood and achieve the desired result. Subjectively, the speaker may not pay attention to feedback, but unconsciously he constantly uses it.
The role of feedback in communication is especially clearly realized if its very possibility turns out to be blocked for a number of reasons. If it is not possible to visually perceive the interlocutor, gestures become impoverished and movement becomes constrained. Signals received when perceiving the interlocutor’s behavior become the basis for correcting the subject’s subsequent actions and statements.
It is impossible to imagine communication processes always running smoothly and devoid of internal contradictions. In some situations, antagonism of positions is revealed, reflecting the presence of mutually exclusive values, tasks and goals, which sometimes turns into mutual hostility - an interpersonal conflict arises.
The social significance of the conflict is different and depends on the values that underlie interpersonal relationships.
In the process of joint activity, two types of determinants can act as causes of conflicts: substantive and business disagreements and divergences of personal and pragmatic interests.
In the event that the interaction of people carrying out well-organized, socially valuable joint activities is dominated by substantive and business contradictions, the conflict that arises, as a rule, does not lead to a rupture in interpersonal relationships and is not accompanied by increased emotional tension and hostility. At the same time, contradictions in the sphere of personal and pragmatic interests easily turn into hostility and enmity. The absence of a common cause puts people pursuing their own selfish goals in a competitive situation, where the gain of one means the loss of another. This cannot but aggravate interpersonal relationships. There are situations when differences in personal and pragmatic interests are covered up by substantive and business disagreements, or when long-term substantive and business disagreements gradually lead to personal hostility. At the same time, differences in personal interests are also found and recorded “retrospectively.”
The cause of conflicts is not overcome semantic barriers in communication that prevent the establishment of interaction.
A semantic barrier in communication is a discrepancy in the meanings of the expressed demand, request, order for partners in communication, creating an obstacle to their mutual understanding and interaction.
For example, a semantic barrier in the relationship between adults and a child arises due to the fact that the child, understanding the correctness of the adults’ demands, does not accept these demands because they are alien to his experience, views and relationships. Overcoming semantic barriers is possible if the medical worker knows and takes into account the patient’s psychology, takes into account his interests and beliefs, age characteristics, past experience, and takes into account his prospects and difficulties.
Like any branch of psychology that has a practical purpose, the psychology of working with patients can encounter resistance.
As R. Konechny and M. Bouhal noted: “The most common thing is to encounter “psychological blindness,” when one does not notice psychological phenomena at all and is absolutely not interested in them. Many people tend to view a person, in extreme cases, in the light of his reflex activity, through the prism of the autonomic nervous system, do not believe in the importance of emotional manifestations, in the possibility of their pathogenetic impact, and behave like that researcher who, having met an animal he had never seen before , simply stated: “Such an animal does not exist.”
Mental factors have to be taken into account everywhere, and especially in the practice of medical activities. Psychology itself is present everywhere, even where it would seem it could not exist. There are various reasons for the resistance that one often encounters in relation to various psychological issues when working with patients.
1. The training of doctors (and nurses) throughout the world is primarily based on the study of physical chemistry, pathology and anatomy. However, the insufficiency of this knowledge alone has become obvious, and in many countries they are trying to change this situation by including the study of psychology, psychiatry and psychotherapy among the compulsory subjects in the training of medical workers.
2. The visible, audible, perceptible, and tangible are considered essential.
3. It is a common opinion that a doctor should be consulted only if the complaints are physically palpable.
4. It is much easier to talk about physical phenomena.
5. The role of technical means has grown, which contributes to the formation of a mechanical approach both among the treating staff and among the patients themselves, and a revaluation of the importance of physical, technical data and results.
6. Lack of time and work overload prevents us from more in-depth treatment of patients, using psychological methods.
7. A certain tradition also influences the views of doctors. They try to help the complaining patient, first of all, trying to detect physical ailments - mental symptoms are given much less importance than somatic ones.
8. For the appropriate application of psychology in practice, every doctor and every sister needs to constantly improve their knowledge of psychology and psychiatry. However, there is still little interest in advanced training in this area.
9. Along with the worldview and training of a doctor, the characteristics of his own personality are of great importance in his activities. Mental disorders, shocks, unresolved conflicts, experiences, etc. have an adverse effect on the personality of a doctor or nurse.
Passive psychological knowledge is often not enough: many cite quotes from psychological sources, give psychological explanations for phenomena, but despite this, their behavior contradicts reality and are unable to understand their patients.
It should be added that the somatic disease itself affects the human psyche, causing various concerns and fears, which, in turn, can worsen the course of the underlying disease and the patient’s condition. The heart, liver and other organs do not become ill in isolation; the disease always affects the entire body as a whole.
An important task is to pay attention to all the mental processes that occur in patients, to their experiences, to reactions, to behavior associated with the disease, to the therapeutic measures that need to be carried out.
The psychological characteristics of the patient in the conditions of therapeutic relationships and interaction come into contact with the psychological characteristics of the medical worker. In addition, persons involved in contact with the patient may be: a doctor, a psychologist, a nurse, a social worker.
In medical activities, a special connection is formed, a special relationship between medical workers and patients, this is the relationship between a doctor and a patient, a nurse and a patient. According to I. Hardy, a “doctor, nurse, patient” connection is formed. Everyday therapeutic activities are connected in many nuances with psychological and emotional factors.
The relationship between doctor and patient is the basis of any therapeutic activity. (I. Hardy).
The purpose of contacts between a patient and a medical professional is medical care provided by one of the participants in communication in relation to the other. The relationship between doctor and patient is determined to a certain extent by the conditions in which medical treatment is carried out. Based on the main goal of therapeutic interaction, it can be assumed that the importance of contacts in the system of interaction between a medical worker and a patient is ambiguous. However, it should not be understood that there is an interest in such interaction only on the part of the patient. A medical worker, in theory, is no less interested in helping the patient, because this activity is his profession. The medical worker has his own motives and interests to interact with the patient, which allowed him to choose the medical profession.
In order for the process of relationship between a patient and a medical professional to be effective, it is necessary to study the psychological aspects of such interaction. Medical psychology is interested in the motives and values of the doctor, his idea of the ideal patient, as well as certain expectations of the patient himself, from the process of diagnosis, treatment, prevention and rehabilitation, and the behavior of the doctor or nurse.
We can talk about the importance of such a concept as communicative competence for effective and conflict-free interaction between a patient and medical professionals. This term refers to the ability to establish and maintain necessary contacts with other people. This process involves achieving mutual understanding between communication partners, a better understanding of the situation and the subject of communication.
Communicative competence can also be considered as a system of internal resources necessary for building effective communication in a certain range of situations of interpersonal interaction. It should be noted that communicative competence is a professionally significant characteristic of a doctor and nurse. However, despite the fact that in a clinical setting the patient is forced to seek help from a doctor, communicative competence is also important for the patient himself. All this is important, because incompetence in communication of at least one party in the communication process can disrupt the diagnostic and treatment process. Therefore, the treatment process may not lead to the desired results. And the patient’s inability to establish contact with a medical professional is just as negative as the medical professional’s reluctance to establish effective contact with any patient.
However, the above does not allow us to remove responsibility for effective interaction with the patient from the medical worker himself.
With good contact with the doctor, the patient recovers more quickly, and the treatment used has a better effect, with far fewer side effects and complications.
The following types of communication are distinguished (S. I. Samygin):
1. “Mask Contact” is a formal communication. There is no desire to understand and take into account the personality characteristics of the interlocutor. The usual masks are used (politeness, courtesy, modesty, compassion, etc.) A set of facial expressions, gestures, standard phrases that allow one to hide true emotions and attitude towards the interlocutor.
Within the framework of diagnostic and therapeutic interaction, it manifests itself in cases of little interest of the doctor or patient in the results of the interaction. This can happen, for example, during a mandatory preventive examination, in which the patient feels not independent, and the doctor does not have the necessary data to conduct an objective and comprehensive examination and make an informed conclusion.
2. Primitive communication. They evaluate the other person as a necessary or interfering object; if necessary, they actively come into contact; if it interferes, they push away.
This type of communication can occur within the framework of manipulative communication between a doctor and a patient in cases where the purpose of contacting a doctor is to receive some dividends. For example, a sick leave certificate, a certificate, a formal expert opinion, etc. On the other hand, the formation of a primitive type of communication can occur at the request of the doctor - in cases where the patient turns out to be a person on whom the well-being of the doctor may depend (for example, a manager). In such cases, interest in the contact participant disappears immediately after obtaining the desired result.
3. Formal-role communication. Both the content and means of communication are regulated, and instead of knowing the personality of the interlocutor, they make do with knowledge of his social role.
Such a choice of type of communication on the part of the doctor may be due to professional overload. For example, at a local doctor's appointment.
4. Business communication. Communication that takes into account the personality, character, age, and mood of the interlocutor while focusing on the interests of the matter, and not on possible personal differences.
When a doctor communicates with a patient, this type of interaction becomes unequal. The doctor considers the patient’s problems from the perspective of his own knowledge and he is inclined to make directive decisions without coordination with the other participant in the communication and the interested party.
Diagnostic and therapeutic interaction does not imply such contact, at least, due to its professional orientation, it does not involve the profession of a medical worker.
6. Manipulative communication. Just like the primitive, it is aimed at extracting benefits from the interlocutor using special techniques.
Many people may be familiar with the manipulative technique, more often called “hypochondrization of the patient.” Its essence lies in presenting the doctor’s conclusion about the patient’s health status in the context of a clear exaggeration of the severity of the detected disorders. The purpose of such manipulation may be: 1) reducing the patient’s expectations for the success of treatment due to the medical worker avoiding responsibility in the event of an unexpected deterioration in the patient’s health; 2) demonstration of the need for additional and more qualified influences on the part of a medical professional in order to receive remuneration.
Communication between a medical professional and a patient can, in principle, be called forced communication. One way or another, the main motive for meetings and conversations between a sick person and a medical professional is the appearance of health problems in one of the participants in such interaction. On the part of the doctor and nurse, there is a compulsion to choose the subject of communication, which is determined by his profession, his social role. And if a patient’s visit to a doctor is, as a rule, due to the search for medical help, then the doctor’s interest in the patient is explained by considerations of his professional activity.
The interaction between patient and doctor is not something set in stone forever. Under the influence of various circumstances, they can change, they can be influenced by a more attentive attitude towards the patient, deeper attention to his problems. At the same time, a good relationship between the patient and the medical professional contributes to greater effectiveness of treatment. Conversely, positive treatment outcomes improve the interaction between the patient and the healthcare professional.
Currently, many experts believe that it is necessary to gradually remove concepts such as “sick” from the process of communication and vocabulary, replacing them with the concept “patient”, due to the fact that the very concept of “sick” carries a certain psychological load. And it is unacceptable to use appeals to sick people like: “How are you, patient?”, and it is necessary to try everywhere to replace this kind of appeal to the patient with addresses by name, patronymic, especially since the name itself for a person, its pronunciation, is psychologically comfortable.
In everyday life we often hear about “good” or “correct” treatment of a patient, and in contrast to this, unfortunately, we hear about “callous”, “bad” or “cold” attitude towards sick people. It is important to note that various kinds of complaints and ethical problems that arise indicate a lack of necessary psychological knowledge, as well as the practice of appropriate communication with patients on the part of medical workers.
Verbal or verbal communication realized through speech. That is why it is called verbal (verbum-Latin: word, verb). Speech performs the function of communication. The communicative function of speech allows you to establish contact between people. The communicative function of speech can be distinguished 3 aspects: informational(speech acts as a way of transmitting information from one person to another and from generation to generation ); expressive(a means of conveying feelings and relationships, in which intonation, expressive, paralinguistic components - gestures, facial expressions, pantomime - are of great importance); speech as a call to action, expression of will. The communicative function is of great importance, organizing the interaction of people. A word spoken by a doctor or other medical professional can dramatically change the patient’s emotional state, his attitude towards the disease, help mobilize strength, but can also cause so-called “iatrogenic”, inspired diseases.
In the system of interpersonal communication, nonverbal communication is very important, which is associated with a person’s mental states and serves as a means of their expression. In the process of communication, nonverbal behavior acts as an object of interpretation not in itself, but as an indicator of individual psychological and socio-psychological characteristics of a person that are hidden for direct observation. On the basis of non-verbal behavior, the inner world of the individual is revealed, the mental content of communication and joint activity is formed. Nonverbal communication is spontaneous, unconscious and nonverbal language shows the attitude towards the communication partner, what a person actually thinks and feels, in contrast to verbal communication, which represents pure, factual information.
More than half of the attention is paid to nonverbal accompaniment of speech. Research by A. Meyerabian showed that in the daily act of human communication, words make up 7%, sounds and intonations 38%, non-speech interaction 55%.
Nonverbal behavior of a person is multifunctional:
Creates an image of a communication partner;
Expresses the relationships of communication partners, forms these relationships;
It is an indicator of current mental states of the individual;
Complements speech, replaces speech, represents the emotional states of partners in the communication process;
Acts as a clarification, changing the understanding of the verbal message, enhancing the emotional intensity of what is said;
Maintains an optimal level of psychological intimacy between interlocutors;
Acts as an indicator of status-role relationships.
Realized and manifested without the participation of consciousness, nonverbal means have independence and can both correspond to incoming verbal information and diverge from it and even contradict it. In the first case, we talk about congruence, in the second, accordingly, about incongruence, which is understood as a discrepancy, a discrepancy between incoming verbal and nonverbal information. With congruence, verbal statements and nonverbal manifestations must match. The contradiction between gestures and the meaning of statements is a signal of lies. For example, a person who says that he is very happy to see N and at the same time takes a closed posture, touches his mouth or nose with his hands, is incongruent, since these nonverbal manifestations indicate that his joy is most likely not sincere.
Research on nonverbal communication shows that nonverbal signals carry 5 times more information than verbal ones, and when signals are incongruent, people rely on nonverbal information in preference to verbal information.
Anyone who has ever visited a doctor or psychotherapist knows that the result of the visit largely depends on the exchange of nonverbal signals during the visit itself. In this section we will look at four aspects related to the treatment of a physical or mental illness in which it is especially important.
- Recognition of the disease. How do clinical professionals recognize different diseases, particularly depression?
- Diagnosis. Does the clinician make the right conclusions about the patient’s problems, condition and prospects?
- Therapy. Is the clinician able to help the patient solve his/her problems and maintain his/her physical and psychological well-being?
- Relationship. Has a positive and trusting interpersonal relationship developed between the clinician and patient?
To achieve each of these goals, nonverbal cues are extremely important. In terms of disease recognition, studying nonverbal behavior and skills can help researchers develop theories about the nature of a given disease. Nonverbal behavior may be one of the symptoms of the disease. For example, one symptom of depression is the expression of sadness, and one of the symptoms of schizophrenia is inappropriate nonverbal behavior. Similarly, one of the symptoms of autism is the inability of sufferers to make inferences about what is going on in another person's head; therefore, the inability to correctly assess the manifestations will be one of the defining symptoms of this disease. Many people with mental illnesses, including depression, schizophrenia, alcoholism (Philippot, Kornreich, & Blairy), and autism (McGee & Morrier), judge the meaning of nonverbal cues less accurately than control subjects. It is currently unclear to what extent the inability to decode nonverbal cues that is so evident in people suffering from these illnesses is due solely to the nature of their diseases and is not a consequence of other factors, in particular a general deficit in cognitive abilities, lack of proper motivation necessary for in order to concentrate on completing experimental tasks, or as a result of taking medications. To definitively answer this question, additional research is needed that includes appropriate controlled tasks along with tests of nonverbal sensitivity.
Non-verbal signs are also important for medical practitioners to diagnose the disease. The work of a doctor and psychotherapist requires special knowledge and cognitive skills acquired in the process of education and training; however, the bulk of their work is interpersonal. Clinicians and patients primarily talk to each other, and therapeutic interventions occur through speech. It is clear that nonverbal behavior is a critical component of this interaction.
Usually the doctor pays attention to non-verbal signs that can shed light on the patient’s problems and the course of the disease. During a visit to a psychotherapist, his ability to “read” signs of emotions, especially those emotions that were not expressed verbally, that deprive the patient of peace of mind or are denied by him, plays a major role. When accepting a patient, the doctor is tuned in to perceive those emotional and psychological signals coming from him, which may be the cause or consequence of his physical standing. For example, after a heart attack, a patient may become depressed.
Many researchers have studied the connection between various nonverbal manifestations and mental disorders. For example, the validity of lowered gaze and slower reactions, a stereotypical idea of the behavior of people in a state of depression, has been proven. It has also been shown that such patients have a decrease in general mobility, decreased expressiveness, they are less talkative, gesticulate less and smile less often, and avoid eye contact; They have stuttering speech and are unable to express emotions.
Some forms of schizophrenia are characterized by an extremely expressionless and monotonous voice; Compared to control subjects, they showed subtle activation of the facial wrinkle muscle (the muscle associated with the eyebrow position that indicates sadness), even when presented with positive stimuli (Krig & Earnst) . Other nonverbal signs of schizophrenia include a sedentary face, inappropriate displays of affect, frequent self-touching, and avoidance of eye contact with others. Some nonverbal behaviors are strongly suggestive of autism and a related condition called Asperger's syndrome, most notably avoidance of eye contact and reduced smiling and gestures (McGee & Morrier).
Another illustration of the use of nonverbal expressions for diagnostic purposes is the detection of pain. Researchers have identified combinations of facial features that are characteristic of pain of various origins in both adults and children (Patrick, Craig, & Prkachin; Prkachin). Common indicators of pain include drooping eyebrows, narrowed eyes, raised cheeks, a raised upper lip, and a wrinkled nose. Analysis of these signs can provide information that cannot be obtained from the patients themselves. For example, patients suffering from chronic or acute forms of temporomandibular disorders and experiencing pain when moving the jaw report that they suffer from this pain equally, but facial indicators indicate that they experience more severe pain when left to their own devices and when undergoing painful procedures (LeResche, Dworkin, Wilson, & Ehrlich). Nonverbal facial cues also help distinguish a person who is really in pain from someone who is malingering (Prkachin).
There are also forms of nonverbal behavior that are associated with Type A personalities (that is, people more susceptible to myocardial infarction): loud and fast speech and other manifestations that indicate aggressiveness. Indeed, the results of many studies suggest that aggressiveness is a precursor to a heart attack. A recent study shows that facial expressions coded according to the Facial Action Coding System are associated with transient ischemia, a condition in which insufficient blood flows to the heart muscle, which can cause serious and even fatal consequences. Interviews with healthy men and men with coronary artery disease were videotaped and necessary physiological measurements were taken. It turned out that patients with ischemia showed more facial expressions indicating anger and more insincere smiles than healthy men (Rosenberg, Ekman, Jiang, Babyak, Coleman). Findings such as these may impact the treatment of these patients.
In the process of training future doctors and psychotherapists, an increasingly prominent place is given to their acquisition of knowledge about communication factors. However, they typically receive inadequate training in how to communicate with patients, including recognizing the patient's condition through nonverbal cues. It is clear that doctors need such knowledge. However, it is very important that doctors not only notice the nonverbal signals sent by patients, but also be able to interpret them correctly. There is a known study in which surgical professors erroneously concluded that students were insufficiently prepared if they looked away during an oral exam. It is important to notice nonverbal signals, but even more important is to correctly interpret them and be able to ignore them if at the moment what the patient expresses in words matters most.
Nonverbal cues can also be used as a source of information about treatment effectiveness. Thus, as a result of psychotherapeutic influence, the sound of the voice, smiles, movements and other forms of non-verbal behavior can change (Ellgring & Scherer; Ostwald).
So far we have talked about how doctors and psychotherapists can use nonverbal cues. But patients also watch them, wanting to see signs of understanding, interest, sympathy or antipathy, or to find peace.
The therapist's nonverbal behavior can contribute to the establishment of a good, trusting relationship and a full exchange of information, that is, the so-called “therapeutic alliance,” but it can also lead to the patient feeling deprived of attention and misunderstood. Both patients and doctors can judge each other's likeability with some, although not very high, accuracy, which can have far-reaching consequences (Hall, Noggan, Stein, & Roter). According to the results of this study, patients who were treated less favorably by doctors were less satisfied with their interactions and were more likely to consider changing doctors. Patients are more satisfied with their interactions with doctors and believe that they show sympathy for them if they make eye contact, lean toward them, nod their heads, come close, and speak in a sympathetic, energetic voice. Sometimes some combination of these nonverbal behaviors produces the best results. Thus, it was shown that patients were most satisfied when the doctor’s negative intonations were combined with his positive words (Hall, Roter, & Rand). Sometimes the nonverbal behavior of doctors can indicate a difficult relationship with patients. The surgeons who were most likely to be sued had voices that suggested they tended to be dominant.
Patients of doctors who are able to understand the meaning of nonverbal cues are more satisfied with their interactions and do not miss appointments (DiMatteo, Taranta, Friedman, & Prince; DiMatteo, Hays, & Prince). The authors of these studies also showed that doctors who more accurately demonstrated nonverbal signs of emotion during a posed task had more satisfied and compliant patients. We don't yet know how these doctors use their good nonverbal skills when communicating with patients, but we can assume that they know how to express sympathy, create an atmosphere of trust, and draw attention to the patient's problems that he has kept silent about.
Today, future doctors know how important good relationships with patients are. It is a fallacy to believe that doctors and patients merely perform well-learned roles, or that doctors are cognitive machines that produce professional behavior without experiencing any feelings. There is always a relationship between clinicians and patients; they may be strictly formal, but they are still relationships. Therefore, everything that we know about the role of nonverbal behavior in the formation of sympathy, attitudes, impressions, mutual understanding, emotions and beliefs is most directly related to them.