On this week’s episode, Dr. Bradley Block shares communication strategies that physicians can use to enhance the efficiency of visits and ensure patients leave feeling satisfied. Dr. Block?

My name is Bradley Block. I’m a private practice otolaryngologist on Long Island, and I’m a partner at ENT and Allergy Associates, which is a practice in New York and New Jersey. I’m the host and creator of the Physician’s Guide to Doctoring podcast, a podcast that helps physicians be the best versions of ourselves in and out of the exam room.

I like to break down nonverbal communication into interest and authority. The patients need to know that you’re interested in who they are as a person, beyond their symptoms. You must be interested in what they have to say, but you also have to establish yourself as an authority. The authority should be assumed because they’re coming to see you, as the expert, but you also have to demonstrate authority, and you can demonstrate that through how you use your voice.

Let’s talk about interest first. Physicians, we have enough on our plate, right? You’ve got to take the history from the patient, examine them, incorporate all that information, any other information they might come with, create an assessment, then a plan, communicate that in a language the patient understands, and then document all of that. We have to do that in a short period of time. It’s a lot to ask—and here I am, asking you to do a little more.

But, I will tell you, if you communicate using these nonverbal cues, it’ll make visits go smoother because the patients are going to appreciate it more. The communication will flow a little more smoothly if they know you’re interested in what they have to say.

All you have to concentrate on is your eyes and the muscles around your eyes. If you are communicating interest, you furrow your brows, squint your eyes, or raise your eyebrows a little bit, and it tells the patient that you’re listening, paying attention, and interested in what they have to say. Now, you can’t fake this. That’s the thing, it seems like it’s performative.

Admittedly, some of medicine is performative, right? A patient comes in to the dermatologist with something that they know is a seborrheic keratosis. If the dermatologist looks at it for one second and then leaves, the patient is not convinced that the doctor cares about them. You really need to look at the lesion, furrow your brows, make sure you’re examining it carefully and it looks like you’re examining it carefully, because even though you could have spotted that a mile away, the patient needs to believe that you genuinely care enough to take the time to examine them thoroughly. So there is an element of being performative in medicine, and this is where this comes in.

But you can’t fake it, because if you’re not genuinely interested in what the patient has to say, they’re going to pick up on the fact that you’re faking these facial expressions. In the other direction, if you’re genuinely interested but stone-faced, you’re not communicating to them that you’re interested. They don’t know that. It’s really important to make sure that you’re using those muscles of facial expression to convey that interest. Those of you that have Botox, it’s going to be a little more challenging. You might want to lighten up in the areas a little closer to the eyebrows and around the eyes, although those are so important for preventing wrinkles and maybe for migraines. But that’s how you’re going to convey interest.

Nodding is something that people often do, but nodding can actually come off as dismissive. So if you’re nodding your head up and down and saying, “Mhm, mhm, mhm,” that might be conveying to the patient that you’re trying to move them through the visit more quickly, that you’re rushing them. But furrowing your brows, that’s an expression of interest.

You don’t have to worry about the rest of your face or what your body’s doing. There’s a lot out there about mirroring, crossing your arms, open body language and closed, but again, we have enough to do. Let’s just focus on this little area and make sure that you’re moving it appropriately. So that’s interest. The second is authority, and that’s conveyed through how you’re using your voice. You’re making declarative statements You’re not ending like a question? Because then that’s going to convey some level of uncertainty. You want to make sure you’re ending on a lower tone to convey that you are an authority in this subject matter.

Another thing you want to avoid is glottic fry, which is where you use your voice like this. Make sure that you’ve got good posture, you’re using enough breath support to make sure that your voice isn’t doing this. Mine is admittedly doing this a little because we’re recording this a little early in the morning.

Another thing that you can do with your voice is take advantage of silence. Pauses. Pauses are going to give your statement more gravity. They’re going to give your statement more gravity… and that’s another trick. Repetition. Repetition can give your statement more gravity.

The other thing that pausing is going to do is give your patient an opportunity to process. It’s giving them permission to process and to take their time, so they don’t feel rushed through the visit. Sometimes, if the patient’s feeling rushed through the visit, they’re going to scramble to try and find more questions to ask because they feel like they’re never going to get a chance to ask these questions again. They just keep asking questions, and it draws the visit out. But using that pause allows them to think about what they are worried about, what they really want to ask. So, paradoxically, it might actually help the visit be more efficient and utilize both the patient and the physician’s time better.

So, again, interest and authority—interest with your facial expressions, and authority with how you use your voice.

With anxious patients, it’s even more important to follow that guide of expressing interest. If patients have anxiety, they’re used to interfacing with the healthcare system in a certain way where a lot gets attributed to anxiety, a lot gets dismissed, they’re not taken seriously, or at least they don’t feel like they’re being taken seriously.

So making sure that you are conveying interest in the patient with anxiety, making sure they know that you genuinely care about what’s going on with them, is going to be even more important. And they need that authority. They need to know that you know what you’re doing, you know what you’re talking about, and you are taking care of them and looking after them. For the patient with anxiety, or maybe the specific health anxiety, you’re addressing them no differently than your other patients, but it just becomes more important for you to convey that interest and authority.

Having been in practice now for a while—I don’t know how that happened, but suddenly I woke up one day and I’ve been in practice for 13 years—it occurred to me that when patients come in, they’re asking me a question about their symptoms. They’re explaining their symptoms to me, but they don’t always explain what they’re worried about, and they often don’t explain why they’re worried about their symptoms.

I like to call that ‘the question behind the question.’

Something that we see commonly in otolaryngology is a globus sensation. A globus sensation is a feeling like you’ve got a lump in your throat. This is the perfect example, because the patient comes in with one of two agendas: “I want to know what this is so I can make it go away. It’s really annoying,” or, “It’s not really that annoying. I can live with this, but can you just make sure I don’t have throat cancer?”

But they don’t say that because they don’t want their doctor to dismiss them out of hand. They sometimes have trouble verbalizing that. It helps to ask them a question like, “What worries you about this? Why are you concerned about this?” so they can say it.

What can happen is, I can examine a patient and make sure that they don’t have throat cancer. But unless I’ve said that, they’re still going to be leaving with that concern. So if we’re talking about making sure that the patients are satisfied, and making sure that our time is used efficiently, it helps to get this information out. Those patients may continue to perseverate and ask more and more questions because you haven’t identified the reason that they’re really there, because they’re afraid to share that with you. Find out what the question behind the question is.

What worries you about this? If a patient comes into urgent care with a cold, we know a cold’s going to go away, and often they know a cold’s going to go away, but there might be something specific about their symptoms, or they just don’t know when the proper time is to go seek medical care. They can use your guidance.

This is a way to make the visit more fulfilling for them and for the doctor, because sometimes it can be frustrating. “Oh, it’s a cold. Why are they wasting everyone’s time in healthcare’s dollars with this?” Well, ask them. How did you make the decision to come here? When do you decide to go seek medical care for this? What is the question behind the question? They need some direction. They need your help. It really helps to identify the question behind the question why they’re really there.

We see a lot of patients every day, especially those of us with heavy outpatient practices. So balancing verbal and nonverbal communication and the question behind the question, it seems like it’s a lot to ask. But I would argue if you just try, and remind yourself every so often to make sure that your face is being emotive, you’re using the cadence and volume of your speech methodically and appropriately, you’re finding out the question behind the question, then you’re not going to have to balance these things.

It’s not about balancing these things against using your time efficiently. These things are going to lead to more efficient use of your time. This should be an incentive to try and utilize these things because the patients are going to appreciate it. They’re going to feel like they’re heard and understood, and they’re going to leave the visit more satisfied. They’re also going to leave the visit a little sooner than if you had been stone-faced, not really understood why they were there, and not communicated in a way where they felt like you knew what you were doing.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.