Reading body language to help navigate difficult patient interactions

When working with a patient population with chronic and terminal illnesses, very often, stressful and difficult conversations take place frequently. Often the news is not good or not what the person wants to hear. Having the assessment skills and knowledge about how to read body language and react accordingly to manage the interaction in a positive way are important skills to have.

Here are 5 tips that can help you navigate difficult patient interactions.

Tip 1. When someone raises their eyebrow, this is a sign that they are not feeling threatened. When you raise your eyebrow, it often elicits a smile from the person your are interacting with, so the next time you receive an eyebrow raise, know you have a good rapport with this person and they are comfortable with you. Why not try to foster a positive response from your patient by raising your eyebrows next time you talk to them? Maybe you will notice that they warm up to you easily.

Tip 2. A person’s eyes dilate strongly when they are stimulated by the conversation and are in a problem solving mode. You may use this to your advantage when you are discussing goals of care and the course of treatment. Paying attention to whether patients and family members have dilated pupils can give you a clue as to whether it is the right time to address important planning issues. When the pupils are dilated, chances are that decisions made will be positive ones.

Tip 3. The first person to look away in an introduction is the more submissive. This can be helpful to understand family dynamics, who the decision makers are, and who is most likely to be leading the family discussions. It can be helpful to determine the hierarchy within a family and whether the people you are dealing with are in a dominant role. They may wish to dominate you in the relationship, which may make the relationship difficult and may be something that you must pay attention to.

Tip 4. If a person’s eyes are moving around and darting from one object to another, they are either nervous or bored. The type of interaction you are having with them will tell you which is true. If you have engaged them in conversation for an extended period of time, you can make an assumption that the conversation is now boring for them. If the conversation is about a difficult subject matter, chances are, they are nervous. You might want to try to reassure them and comfort them if it is a necessary discussion.

Tip 5. A clue about whether someone is being open and honest is whether they are showing their palms. If palms are displayed, they are telling you the truth. If you talk with your palms facing upwards, it forces others to speak truthfully too.

Niamh van Meines is a nurse practitioner who blogs at Hospice Navigator.

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  • PamC

    Half the time doctors *think* it’s something patients don’t want to hear. Sure the reaction may be bad. But a lot of times folks have been searching for answers to the riddle and are /relieved/ to get a diagnosis, whatever it is.

    They’ve already been suffering through it. All you’re doing is giving it a name. Read patient boards like on You’ll see there that the struggle to know is what is frustrating to *many*. The diagnosis is usually prefixed with, “Well they finally figured out what’s wrong…”

  • carolyn thomas

    I hardly know where to start here, except to say that while body language – and more appropriately, the ability to sensitively pay attention to a patient’s body language – is certainly important in communication, some of your pointers here seem fraught with the very real risk of gross misinterpretation if applied as literally as you seem to be suggesting. 

    For example, a patient’s raised eyebrow MIGHT make you think “you have good rapport with this person”, but it could just as easily mean: “Oh, really? I’m not buying that!”   The first person to look away in an introduction MIGHT be “the more submissive”, but eyes down could just as easily be due to a patient’s distressing symptoms you aren’t even aware of. And conversely, the one in the room who doesn’t look away need not be the one who “wants to dominate you and make the relationship difficult..” 

    “Palms facing upwards” will make others tell the truth?  Good grief.

    Sometimes, a person will cross their arms tightly across their chest NOT because they’re antisocial or uncooperative or hostile, but simply just because the air conditioning is set too high. . . .

    • Niamh van Meines

      I’m sure in each situation we can make the right judgment whether the person is hostile or cold based on the information we gather. It’s just another tool in the tool box to pay attention to people’s body language. Some of us are intrigued by people’s quirks and behaviors. It can help to guide the discussion or interaction. No exact science here or need for it either! Just an interest in the patient / practitioner relationship. I would be inclined to sit down to put an obviously submissive person at ease, or stand far away from a person who appears to be hostile. Thanks for your comment, I know it’s not for everyone!

      • Anonymous

        Sometimes a person will cross their arms tightly across their chest because they don’t feel safe or feel anxious.

        So all my doctor’s think I am hostile?

        • Niamh van Meines

          I doubt it.

  • Kaitlin Blazejack

    This is a tough issue, not simply because of what people have mentioned here, but also because every culture is different. I may look as white as a ghost, but I have some Native American Ancestry. It’s considered almost rude to look someone directly in the eye, especially during difficult conversations. There are so very many facets like these to body language in the practitioner-patient relationship that, unfortunately, I think sensitive patients often end up blaming themselves when they read posts like this. As ‘e_patient’ mentioned, do my doctors think x because I’m doing y? It’s stressful enough to have a chronic condition without having to worry that you’re going to be *that* patient that the whole office dreads seeing on the schedule.

  • tribhuvan

    all five points are not universal,all depends on localised traditions.Doctors conversation with patient is depend on friendly with kindness,its not depend on eye movement.Yes some addicted patients can do like above 5 points.

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