Beyond the Words... 5

Communication is about much more than words and that meaning is also conveyed by silence and body language.

Silence: may convey or be interpreted as:

• Respect by some Hispanic groups
• Embarrassment by some Asian cultures
• Serious or very important matters being discussed by some Europeans
• Fear by some South-East Asian groups
• Disdain (question not worthy of answer) in some African-American groups

 

Eye contact: In several cultures, the physician’s gaze is regarded as necessary to diagnose the health problem and even as therapeutic, especially in ensuring trust and respect from patients.

• In these cultures, if the physician averts or avoids eye contact, it can signal disrespect for the patient, lack of interest in the case, shame/embarrassment about not knowing what to do, or a bad prognosis.
• Conversely, in these cultures, the patient may avoid eye contact out of shame or anger.
• Patients from several Asian and African groups may avoid eye contact as a sign of respect for the physician and this can be mis-interpreted as depression.

 

Smiles: In some Asian groups, smiling is inappropriate except between equals during social occasions, whereas other use smiling and giggling to cover embarrassment.

Physician smiling during a clinical encounter indicates a flippant attitude and lack of concern for the patient in some Eastern European countries.

 

Physical proximity: Most North Americans communicate most comfortably with about four feet distance between individuals.

• For many Hispanics, the distance is closer to two feet, whereas for many Britons, it extends to about five feet.
• Patients may move into the physician’s “personal space” or pull away from the physician in order to feel more comfortable.
• These moves could be interpreted as inappropriately intimate or signaling fear/distrust respectively.

 

Common gestures: Nod of the head indicating “yes” or agreement in USA and many other cultures has the opposite meaning in Greek and some Mediterranean groups.

• Indicating “come here” with the index finger as is common in USA, is regarded as very insulting in the Philippines.
  Touching on the head is a very serious insult to South East Asians as the head is the seat of the soul.
• Conversely, using or showing an “unclean” body part is a huge insult in several cultures. As the soles of the feet are in contact with the ground, pointing these at someone from certain cultures is highly insulting – this can occur if the physician has legs crossed and ankle flexed, or be forced on a patient who is placed in stirrups for gynecological examination.
• In several Middle Eastern countries, the left hand is unclean and must never be used to touch or give items to a patient. Conversely, in other cultures, items given with both hands have more significance.