CanMeds Communicator
Non-verbal Communication

Non-verbal Communication




First impressions impact greatly on a patient’s confidence in their physician’s skill. 

When meeting a patient for the first time, there is an initial "test" period where the patient is deciding whether or not to trust the health care provider.  This is quite obvious for residents and learners.  Patients will often ask the attending physicians the same questions that they asked the resident in order to double check their information.  This re-checking of information can also be related to trust and verbal and non-verbal communication issues.

Stuart Foxman has written a review article for the CPSO journal Dialogue [1].  He describes that face to face communication has three components:

  1. Verbal (the words we choose)

  2. How we say the words (tone, pitch, volume)

  3. Non-verbal (body language).  


Of these three components of communication, the verbal part accounts for 7% of how a message is conveyed. How we present a message (and not the actual words that are used) accounts for 38%.  So, the speed and tone of our voices have a larger effect on your message that the actual words you say.

Most surprisingly, body language is responsible for over half, 55%, of our messageFacial expressions, gestures and posture have a huge impact on the actual words we use

In this same article, Foxman describes one medical school in Arizona which is teaching non-verbal communication to their students by taking them to a horse ranch.  Apparently, horses are very sensitive to body language.  Students become aware of their own body language while using their posture, eye contact, movement and breathing to encourage the horses to perform simple activities.


    What we say - 7%

    How we say it - 38%

    Body language - 55%


Developing a "mind’s eye" or a visual image of oneself can help you remember that how you appear to the patient is important.  Watching yourself on video can also be very helpful in getting a feel for gestures and postures that you use  which may or may not be effective with your patients. Some of you may have videotaped yourself during a patient care encounter.  Did you find this helpful? 





Below are some comments patients have made about resident learners:

  • "I just didn’t trust him.  First of all, he wasn’t wearing any socks which is so unprofessional"

  • "She wouldn’t look me in the eye so I didn’t know if she was paying attention or thinking of something else"

  • "Her shirt was so short I could see her belly.  I don’t think she was interested in me, I think she just wanted to look good"

  • "He was slouched in his chair the entire time, he looked bored to me"

  • "The residents are always looking at the computer and typing.  The visit is so impersonal now"

  • "My daughter, who is usually cooperative, becomes very distressed when the resident comes in and just starts talking to me, about her, and never engages with her."




What do you think about the above comments? Are they reasonable or unreasonable to you?


What are some of the factors that could be influencing these patients and their comments? Are gender or cultural issues relevant here?





1. Foxman S. Body of Knowledge. CPSO Dialogue. July 2009;5:25-28. Available online: accessed May 11, 2010.

All references for this section