On my very first day of the Miller-Coulson elective, I eagerly entered the first patient room excited to observe the many dynamics of doctor-patient communication. A young man had traveled from another country with his parents to discuss the need for brain surgery to remove a tumor causing frequent seizures. I was curious to see how the neurosurgeon would discuss such a serious procedure while building trust with a family and addressing their concerns.
To my chagrin, I entered the room and could not understand anything. Fortunately for the family, Dr. Quinones spoke Spanish and they greeted him with hugs and kisses. Unfortunately for me, my Spanish skills were minimal at best. I had signed up for the Miller-Coulson elective to have the unique opportunity to learn communication skills by observing the “best of the best” at the bedside, and I wrongly assumed, in that moment, that I would have to wait for the next English-speaking patient encounter for this experience to really begin.
I soon realized my mistake as I recognized that in this setting, I had the unique ability to focus solely on the non-verbal cues within the discussion. For example, I noticed that Dr. Quinones walked in the room and greeted the family very warmly, with strong handshakes for the son and father, a hug for the mother, and smiles for all. When he sat down he turned his chair away from the computer and faced the family. More specifically, he angled himself towards the son. Later in the interview he would look at the parents to address their concerns, but through his body language, he made a point of identifying the patient as his primary concern while still validating the parent’s importance.
Throughout the interview, I noticed an augmentation and lowering in the tone of Dr. Quinones’ voice. Initially, his voice was enthusiastic and uplifting as they talked about life outside of medicine. Then as he began interviewing about symptoms and listening to the patient’s story, his tone quieted and softened. Most importantly, I heard his voice hardly at all as the son did most of the speaking. During this time, Dr. Quinones looked at him intently. After the son finished speaking, there would often be a pause before Dr. Quinones said something, as if he was still critically thinking about what was just shared. This reminded me of a quote I had heard previously: “Most people do not listen with the intent to understand; they listen with the intent to reply.” It was clear, however, that Dr. Quinones was not just waiting until the patient finished talking to reply; instead, he was digesting every word of the patient’s story.
When it was Dr. Quinones’ turn to speak, I noticed he spoke slowly. I could recognize that he said some of the same words twice, as if he repeated himself to ensure comprehension. He would pause his speech until the family members nodded. When the mother’s eyes began to tear, he reached and touched her on the arm while speaking in a calming voice. He paused and asked: “Preguntas?” After some serious moments, Dr. Quinones would say something and grin, and then the family would erupt with laughter. The serious tone would again return, but the environment seemed a bit more optimistic. Throughout the interview, Dr. Quinones would often use his hands to dramatize his speech, and he continued to sit at eye-level with the family throughout the interview.
During the next two weeks, I made it a point to observe the non-verbal communication skills of other Miller-Coulson Academy Members. There were other instances when a physician’s body positioning helped to focus on the patient and take the focus away from an over-bearing family member. In other instances, I noticed how touch, hand gestures, or even humor were used to emphasize a point or comfort a patient. I am grateful that my first patient encounter during the Miller-Coulson elective brought my attention to non-verbal cues so that this would be a focus for the rest of my experience.
Shannon Walker, MSIV