2 Communication Techniques: Non-Verbal

We spend a lot of time considering what we want to say and how best to say it, but the truth is that 80% of our communications occur on the non-verbal level. We interpret each other’s stance, the space around us, the tone of voice used, even where we are looking, and use that to frame the situation, including the words we’re hearing.

Non-verbal communication can be described as those behaviors between the veterinarian and client that reflect the emotions or tenor of the interaction. Interpretation of non-verbal indicators can help veterinarians clarify client concerns that they may be unwilling to voice. However, because people may show a given behavior for more than one reason (is she crossing her arms because she doesn’t want to hear this or just because she’s chilly?), it’s always best to follow up an interpretation of a non-verbal clue with a question (“Are you okay with this information, Mrs. Johnson? Is the room too cold?”).

Conversely, awareness of one’s own non-verbal indicators also may minimize miscommunications. It can be difficult to know what clients are thinking; in human medicine, it’s been shown that doctors who sent non-verbal indicators of being agitated or worried were considered to be more concerned for their patients. Clients are very unlikely to verify their perceptions of your non-verbal cues so it’s very important to minimize mixed messages. Asking a horse owner if they have any other questions while you stand with your back to them putting things in your truck sends a very clear signal that you don’t really want to answer any more questions for them that day.

Non-verbal communication can be further broken down into four categories:

1) Kinesics: To touch or not to touch?

Kinesics is what most people call “body language”, the conscious or unconscious use of gestures and body motions, including facial gestures, to communicate. One of the simplest and most important non-verbal communication tools is use of eye contact. It can be difficult to maintain eye contact while trying to write down a history or perform a physical exam on an animal, but intermittent eye contact lets the client know you’re attending to them. Similarly, looking directly at a client while presenting information signals confidence in what you’re saying.

Touching can be a powerful form of non-verbal communications but it can also be very tricky to use properly. Some clients are huggers and some definitely are not; the same is true for veterinarians.  Some clients appreciate being touched; others will consider it harassment. The safest course is not to touch or hug clients; in those situations where you think it may be appropriate, ask permission, first.

As you’re attentively listening to the client tell their story, make sure your body language is emphasizing your confidence and willingness to engage in conversation. Sit or stand straight, perhaps leaning slightly forward. Listen closely and take notes when appropriate. Be comfortable, not jittery and jumpy.

2) Proxemics: Personal space

Dr. Edward T. Hall^[1] identifies four distinct zones of personal space. These are (1) intimate space, (2) personal distance, (3) social distance, and (4) public distance.

Intimate space is self-explanatory; you are very aware of your partner. When we are forced into intimate space, for example on a crowded elevator, we become very rigid as a way of telling others, “I know I’m in your intimate space but I’m rigid and I’m not looking at you so you know it’s not on purpose.” This varies by culture.

Personal distance is the space where one is attached to the person with whom they’re communicating but still willing to leave some room for movement. An example is the distance a mother will allow her child to wander from her while shopping.

Social distance is the distance at which we transact impersonal business and is, therefore, the distance at which we’ll most commonly speak with clients. This space can be altered by how you and client face each other, who’s sitting and who’s standing, if there’s a barrier in the way (exam table, bales of hay), and how noisy the room is.

Public distance is that used when speaking to a group of people. You will stand farther away from a group of workers at the humane society when addressing them than you would if having a conversation with one individual.

It’s also very important to think about how you impose upon others by using space. Tall people can easily loom over smaller people and unconsciously intimidate them. Dr. Root once had a client come in that called ahead to let her know that he had a brain injury that made it hard to talk to large groups of people, so she and the students were very conscious of keeping their distance and not overwhelming him. He moved from being seated in a chair to sitting on the floor; they all sat on the floor, too. As he talked and moved around, some of them were almost reclining, trying to make sure he was comfortable. It was a great conversation and they did convey all the information he needed regarding whether or not to spay his dog but it was fascinating to watch, from a proxemics standpoint.

3) Paralanguage: The tone of the voice

A high-pitched, nervous speaker makes others feel anxious. If you’ve ever tried to work when you’ve had laryngitis, you know that everyone you whisper to whispers right back to you. Listen to yourself so you know how to project calm and confidence in your voice. Many of us have our “normal” voice that we use during non-veterinary conversations, and a voice that we use when talking to clients.  In fact, our friends and family can often tell when we are speaking on the phone with clients based on how we sound.

Your choice of words also can be powerful. Think of all the ways you can say, “I knew you’d be here.” Some of them are welcoming, some accusatory. Think about the words we commonly use (carcass, blue juice) that are not acceptable to clients.

Silence can be a powerful part of language. Times to use silence include when you want a client to elaborate on something they’re saying; to drive home a critical point; to permit a client to write something down or look something up; or when someone asks you a question to think about how best to phrase the answer. Silence can also be used in a detrimental fashion. This most commonly occurs on the telephone, when someone wants something from you and so just sits silent, waiting for you to babble something just to keep the conversation going. Do not fall for this tactic and do not use it yourself.

Non-verbal forms of communication, such as telephone conversations and email messages, require strict attention to word choice and to paralanguage. You can tell when you talk with someone on the telephone whether or not they’re smiling, just by how it changes the tone of their voice. You also can tell when they’re multi-tasking; it is a great rudeness to talk to clients on the telephone while you’re completing another patient’s chart on the computer or going through the drive-through over your lunch break.

Email communications can suffer from misinterpretation of language used. Sarcasm and humor do not always translate well into email messages and should be used sparingly. Do not use abbreviations as for texting while sending a business email; you are a professional and any written communication with a client or colleague could someday be part of a legal medical record. Use proper grammar and punctuation, and keep email messages concise and clear. One author suggests that you should not send as an email message anything that is likely to cause a strong emotional response. The American Medical Association has created email guidelines for physicians. They recommend email for reiterating information that is difficult to remember (phone numbers, instructions, names), giving links to online resources, and for communications with clients who have specifically requested it. They do not recommend email for anything private, confidential, or sensitive.

4) Autonomic shifts: I’m blushing!

There is nothing you can do about these automatic responses of your body. Perhaps it’s best to worry less about whether or not you’ll show these responses and to worry more about learning to recognize them so you can verify a client’s concerns verbally. For example, a person with a flushed face who is breathing quickly and deeply probably is angry.

You should not expect yourself to be able to recognize a client’s thoughts through their non-verbal indicators but you must be observant of them. Only when clients feel mentally and physically safe will they be able to explain their concerns with you, including concerns about their pet, their personal finances, or their family farm. People who feel unsafe appear defensive or frightened. Watch especially for people who clearly do not feel safe, based on non-verbal indicators (crossed arms, shifting weight, lack of eye contact) but who tell you they are fine. That non-congruence is an indication of a communication breakdown. You can lead a client to safety by trying to match their non-verbal indicators. If they’re sitting, sit down. If they’re leaning away from you, don’t lean in closer. You also can try leading, using non-verbal indicators to calm a client or encourage them to open up. If they’re standing and rocking back and forth, try sitting down or leaning against the wall in a relaxed manner. Most of us will unconsciously mirror the non-verbals of those around us; watch everyone at a dinner party sometime and see how many cross their hands over their plate or take a drink of water after you do.

Ultimately, non-verbal communication skills are worth honing:

• Non-verbal skills enhance relationships
• Non-verbal skills take no extra time

Non-verbal Rapport Building: Matching and Leading

Rapport building with matching and leading is the non-verbal structure of empathy. There are two key components that include matching and leading. Matching is simply the process of moving as the other person moves. You may think of it similar to mirroring to acknowledge the state of behavior they are in through reflection. You can use any aspect you notice such as facial expression, voice volume and rate, body postures or gestures. Clients typically experience a feeling of ‘being understood’ by the veterinarian. Leading is the utilization of the synchrony set up by matching. Leading invites the client to move with you and will likely produce a reciprocal response.

Other Factors Affecting Client Perceptions

Another component of the non-verbal message you send is professional dress. That dress may vary, depending on what kind of animals you work with and what part of the world you are working in. In general, hair should be neat, clothing should be clean and modest, and jewelry should not present a danger to you or the animals.

Finally, consider the message sent by the hospital or facility where you work. It is important to think about the space in which you work. What does your truck look like? Is it well organized or messy inside and rusty outside? Is feces picked up and snow shoveled outside your small animal hospital? How does it smell? How do you look? Would a client worry about you possibly spreading disease by the state of your coveralls, jeans, or lab coat? Clients, vendors, potential sponsors, and anyone else who walks through the hospital door starts making assumptions about you and the quality of your work based on the cleanliness of the environment and other non-verbal factors.

Here is an example of a list of signs sent by your waiting room to suggest that you are not putting clients first:

• Difficult to find seating
• Difficult to navigate with a pet
• Noisy, smelly
• Feels more like a retail store than a doctor’s office
• No place for clients to have private conversations or make phone calls