title: Verbal and non-verbal behaviour and patient perception of communication in primary care: an observational study.
abstract: BACKGROUND
  Few studies have assessed the importance of a broad range of verbal and non-verbal consultation behaviours.
  
  
  OBJECTIVE
  To explore the relationship of observer ratings of behaviours of videotaped consultations with patients' perceptions.
  
  
  METHODS
  Observational study in general practices close to Southampton, Southern England.
  
  
  METHODS
  Verbal and non-verbal behaviour was rated by independent observers blind to outcome. Patients competed the Medical Interview Satisfaction Scale (MISS; primary outcome) and questionnaires addressing other communication domains.
  
  
  RESULTS
  In total, 275/360 consultations from 25 GPs had useable videotapes. Higher MISS scores were associated with slight forward lean (an 0.02 increase for each degree of lean, 95% confidence interval [CI] = 0.002 to 0.03), the number of gestures (0.08, 95% CI = 0.01 to 0.15), 'back-channelling' (for example, saying 'mmm') (0.11, 95% CI = 0.02 to 0.2), and social talk (0.29, 95% CI = 0.4 to 0.54). Starting the consultation with professional coolness ('aloof') was helpful and optimism unhelpful. Finishing with non-verbal 'cut-offs' (for example, looking away), being professionally cool ('aloof'), or patronising, ('infantilising') resulted in poorer ratings. Physical contact was also important, but not traditional verbal communication.
  
  
  CONCLUSIONS
  These exploratory results require confirmation, but suggest that patients may be responding to several non-verbal behaviours and non-specific verbal behaviours, such as social talk and back-channelling, more than traditional verbal behaviours. A changing consultation dynamic may also help, from professional 'coolness' at the beginning of the consultation to becoming warmer and avoiding non-verbal cut-offs at the end.
authors.affiliation: Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Nightingale Surgery, Romsey.
authors.forename: Peter
authors.initials: P
authors.lastname: White
authors.affiliation: Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
authors.forename: Hazel
authors.initials: H
authors.lastname: Everitt
authors.affiliation: Primary Care Group, Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton.
authors.forename: Shkelzen
authors.initials: S
authors.lastname: Gashi
authors.affiliation: General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Bikker
authors.affiliation: General Practice & Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
authors.forename: Stewart
authors.initials: S
authors.lastname: Mercer
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009633:Nonverbal Communication; D009819:Office Visits; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D012017:Referral and Consultation; D012938:Social Perception; D011795:Surveys and Questionnaires; D014705:Verbal Behavior; D014741:Video Recording
keywords: communication; consultation; general practice; non-verbal communication