Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare Outcome

Abstract

Communication is essential during clinicians' patient encounters in determining the health outcome. The importance of nonverbal communication has received less attention in the patient direct care model, both in practice and healthcare communication. This is because of the nature of the approach itself. Our goal was to investigate the impact nonverbal communication research conducted during the last quarter century has had on various health outcomes. Body language is a powerful tool that may help healthcare providers connect with patients and build mutual respect. In the context of medical encounters, this research aims to provide a summary of the previous research that has been conducted on nonverbal communication. After giving the roles of nonverbal behavior and its importance in medicine, we show how physician nonverbal conduct relates to patient pleasure, trust, or adherence. We then present nonverbal behavior assessment tools. Finally, it has been determined whether or not interpersonal sensitivity affects patient outcomes.

Full text

Research Article ISSN 2313-4747 (Print); ISSN 2313-4755 (Online)
Asian Business Consortium |
AJTP
Page 43
Nonverbal Communication in Clinician-Patient
Interaction and Influence on Healthcare
Outcome
Alphonse Ekole
1
Family Medicine Specialist, Ascension Saint John Hospital, Detroit, MI 48236, USA
ived: Jun 12, 2017; Accepted: Jun 27, 2017; Published: Feb 20, 2017
ABSTRACT
Communication is essential during clinicians' patient encounters in determining the health outcome.
The importance of nonverbal communication has received less attention in the patient direct care model,
both in practice and healthcare communication. This is because of the nature of the approach itself. Our
goal was to investigate the impact nonverbal communication research conducted during the last quarter
century has had on various health outcomes. Body language is a powerful tool that may help healthcare
providers connect with patients and build mutual respect. In the context of medical encounters, this
research aims to provide a summary of the previous research that has been conducted on nonverbal
communication. After giving the roles of nonverbal behavior and its importance in medicine, we show
how physician nonverbal conduct relates to patient pleasure, trust, or adherence. We then present
nonverbal behavior assessment tools. Finally, it has been determined whether or not interpersonal
sensitivity affects patient outcomes.
Keywords: Nonverbal Communication, Health Care Outcome, Clinician Patient, Community Medicine,
Patient Education and Counseling
INTRODUCTION
This review aims to identify the effect of nonverbal
communication on a patient's health outcome during
patient-directed care. Clinicians-patient communication is
a critical component in determining health outcomes in
disease management. In addition, the patient-centered
communication model has widely been advocated to
achieve a favorable outcome. Several recent studies
highlight the importance of non-verbal communication
and its implication on patient satisfaction and other health
outcomes (Mast, 2007).
Nonverbal communication and non-verbal behaviors are a
variety of communicative interactions that carry no
linguistic content, including but not limited to; facial
expression, smiling, eye contact, body posture (open or
closed position), forward or backward leaning, hand
gesture, head nodding, paralinguistic speech
characteristics such as speech loudness; rate; pitch; pauses
1
Dr Alphonse Ekole MD, MSc., CFNM. is a Family Medicine Specialist in Eastpointe, MI, with over 27 years of experience in the medical field. He
graduated from Universite de Yaounde I, Faculty of Medicine and Biomedical Sciences, in 1995. He also holds a master's degree in Clinical Research
from Drexel University. He (is) affiliated with Ascension Saint Johns hospital and is Associate Program Director of the Family Medicine Residency
Program of Detroit Authority Health. He is an Adjunct Prof. of Clinical Medicine at Michigan State University and Wayne State University. Email
for correspondence: draekole@gmail.com
and dialogue. Behaviors such as interruptions, empathy,
and emotional connection. These non-verbal
communications convey relatedness (Caris‐Verhallen et
al., 1999; Zolnierek & DiMatteo, 2009). This review
considers nonverbal communication and nonverbal
behaviors to share the same message.
Communicating nonverbally correlates directly to a
clinician's emotional intelligence (EI) and empathy
(Burcher, 2011). How a clinician relates to his or her patient
may influence patients' satisfaction, trust, compliance to
treatment, and prognosis, which are outcome markers of
quality of care. There is a positive correlation between
physician emotional intelligence (EI) and health care
outcome markers, particularly trust. Patient trust is a
marker of the quality of healthcare experience.
Considering the pivotal role that non-verbal
communication plays in the care process, it has received
extraordinarily little attention in medical education and

Ekole: Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare Outcome (43-50)
Page 44 American Journal of Trade and Policy ● Vol 9 ● Issue 1/2022
healthcare communication literature. Nonverbal cues and
behaviors to decipher meaning during care have been
replaced by more verbally explicit exchanges, with little
reliance on the unstated. Nonverbal cues influence the
interaction results, and clinicians must take necessary
signals (indicators) from the patient to foster the purpose
and goal of the encounter, including future meetings.
REVIEW OF THE RELATED LITERATURE
Studies on caregiver-patient nonverbal behavior have
yielded many interesting results in recent decades.
Nonverbal communication predicts patient outcomes in
correlational and experimental studies. Leaning forward
and smiling boosts patient satisfaction, trust, and
adherence. We learn how patient characteristics affect
communication style reactions. Studying caregivers' and
patients' nonverbal behavior. Nonverbal behavior can
reveal disease in psychotherapy (e.g., depressive disorder,
schizophrenia, autistic troubles). Furthermore, enhancing
patients' nonverbal skills, such as reading and interpreting
others' nonverbal behaviors, can be part of therapy (Cousin
& Mast, 2014). Finally, as caregiver-patient communication
developed, theoretically and empirically, we learned how
physicians, nurses, therapists, and other healthcare
providers should best communicate with their patients,
interpret their nonverbal behavior, and adapt to it to
ensure the best possible care.
Patient Satisfaction
Patient satisfaction is a measure of the level to which a
patient is a content with the healthcare they receive from a
healthcare provider. It is an essential and commonly used
indicator of the quality of healthcare experience by most
health insurance providers (Kravitz, 1998; Thiedke, 2007).
Measured appropriately, patient satisfaction or experience
provides a measure of the quality of care and provides
understanding into a characteristic that is otherwise
challenging to objectively measure (Manary et al., 2013).
Studies of eye contact, facial expression, body positioning or
leaning forward, and visibility of actions (Hannawa, 2011)
show a strong association with patient satisfaction (Griffith
et al., 2003). Gentle touch, gesturing, and head-nodding also
equally impact patient satisfaction. A physician's smile
affects patient satisfaction but does not influence trust
(Griffith et al., 2003). Conversely, there is a negative
association between patient satisfaction and clinician facial
expression and/or eye gaze (Rahman et al., 2017).
Patient trust and nonverbal communication
Patient trust is an important fundamental element of
medical treatment relationships. Trust in health care
interaction is threatened and rapidly eroding by the rapid
changes in the health care systems (Pearson & Raeke, 2000).
Patient trust has been established to predict instrumental
variables of health quality, such as adherence to treatment,
preventive services, and continued enrollment or keeping
appointments (Thom et al., 2004). Nonadherence to a
recommended treatment carries a significant economic
burden. For example, in some disease states, more than
40% of patients sustain significant risk by nonadherence to
treatment (Martin et al., 2005). Many studies have linked
patient trust to certain nonverbal communication styles of
eye contact (Hannawa 2014, Hannawa, 2011), facial
expression, gestures, head nodding (Hannawa, 2014), body
position, leaning forward, and visibility of action
(Hannawa, 2011). Face and/or eye gaze negatively
influence patient trust (Mast & Cousin, 2013). It has also
been demonstrated that a physician's nonverbal behavior
that conveys concern to a patient, such as maintaining
frequent eye contact, displaying an expression of concern
on their face, or keeping a close interpersonal distance,
results in a greater degree of patient trust than a
physician's behavior that conveys a greater degree of
stretch. Regarding patient adherence, it has been
demonstrated that a physician touching the patient
increases the patient's commitment to their medication
(Mast & Cousin, 2013).
Compliance to follow instructions and continue care
Compliance refers to the degree to which a patient’s
actions align with the recommendations made by a
healthcare provider (Winnick et al., 2005). One study found
a correlation between vocal tone, eye contact, facial
expression, and compliance to follow instructions and
continue care among Southeast Asian physicians and
patient’s interactions (Coelho & Galan, 2012). DiMatteo et
al. (1986) studied 28 family practice residents' self-reported
empathy, self-monitoring ability, and emotional
communication skills as predictors of patient satisfaction,
appointment noncompliance, and physician workload.
Appointment records were utilized to establish how many
patients each S and ANC saw. Self-reported ANC and PS
were unrelated to physician workload, although affective
communication competence was. Sensitive Ss had fewer
cancellations. Nonverbal encoding skill was linked to
patient satisfaction and physician workload.
METHODS AND MEASURES
The literature of published articles in the English language
was searched within the last 25 years using standard terms
about nonverbal communication and health outcomes
using NLM, google scholar, and Mendeley. We found
many articles on nonverbal communication. In addition,
we targeted articles focused on patient satisfaction
outcomes, trust, compliance or adhesion to treatment,
medical error forgiveness, and emotional relatedness.
Forty articles met the criteria and were studied.
The measures promote patient adherence and can lead to
cost savings and better patient outcomes. Although these
outcomes are encouraging, physicians have limited time
and funding and must implement these tactics in a busy
practice. No one intervention technique has been proven
effective across all conditions and contexts; hence, a
combination of the following strategies is generally needed

Research Article ISSN 2313-4747 (Print); ISSN 2313-4755 (Online)
Asian Business Consortium |
AJTP
Page 45
to improve patient adherence. We present a conceptual
framework based on our literature review and the advice of
influential organizations to bridge the gap between research
and clinical reality. This multidisciplinary framework looks
at methods in the context of the healthcare team and system-
related issues to reduce implementation time and cost (see
Figure 1). The framework views patient adherence as a
systems problem, not a patient or physician one, and
integrates interventions at the systems level. In the
framework, nurses, pharmacists, case managers, health
educators, and everyone involved in patient care know their
roles. Understanding and appreciating a pharmacist's role in
educating patients about medications may allow doctors to
focus on other therapeutic components. For example,
community pharmacists can promote drug regimen
adherence by providing patients with drug information,
recognizing potential adverse drug reactions and
interactions, and offering suitable dosage containers or
compliance aids. In addition, nurses or other healthcare
workers can mail appointment reminders and patient
education materials. Atreja et al. (2005) say adherence is a
dynamic process that needs evaluation. Closing the
feedback loop requires good assessment, which involves
creating criteria to gauge adherence and analyzing
procedures and outcomes. Creating institution-wide groups
to create and implement strategies would help integrate the
recommendations into current systems and increase quality.
Figure 1: Systematic framework to improve adherence
FORMATS FOR DOCUMENTING AND ANALYZING
NONVERBAL BEHAVIOR
There are a variety of approaches that can be taken to
operationalize the documenting and analyzing of the same
nonverbal action. For example, code how many times a
person smiled or how long that person smiled during the
interaction. Alternatively, you could use a global rating of
how "smiley" that person appeared during an exchange,
which could be a combination of the smiles' frequency,
duration, and expansiveness. For example, you could code
how many times a person smiled or how long that person
smiled during the interaction (Blanch-Hartigan et al.,
2018).
Table 1: Structures for Documenting and Analyzing Nonverbal Behaviors
Documenting and
analyzing the format
Case in point
Incidence tally
The incidence tally is the number of times an activity was observed, regardless of
duration. For example, how often a doctor looked at a patient's chart.
Typical length
The typical length divided by frequency equals average duration (e.g., average speech
duration would be total speaking time divided by the frequency of several turns).
Aggregate time
Speaking time and eye contact are commonly measured cumulatively.
Dimple ratings
Global dimple ratings are abstracter than one-behavior ratings. Physician dominance can
range from 0 (not dominating) to 5 (very dominant). The problem is determining which
sample values represent 0 and 5.
Intensity
Over the whole engagement duration or over a predefined time limit, the behavior's
intensity is scored (e.g., how much empathy a physician showed during an interaction).

Ekole: Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare Outcome (43-50)
Page 46 American Journal of Trade and Policy ● Vol 9 ● Issue 1/2022
Rate per unit of time
A rating is assigned to the conduct throughout a period that has been predetermined,
such as once per minute.
Evaluation measures with
appropriate presenters
These are measures of specific behavior, such as how much a patient smiled, on a scale of
0 to 5. (a lot). The problem is determining which sample values represent 0 and 5.
Existent or absent-
minded
A predetermined interaction period is used to code behavior. This sequence can be the
whole conversation (e.g., was the consultation interrupted, yes or no) or the presence or
absence of the behavior in a pre-specified time interval (e.g., did the physician make eye
contact yes or no during 1 min, during the next min, etc.). In the second situation,
documenting and analyzing can be done during interactions.
Uncompromising
documenting (type)
When documenting and evaluating diverse behaviors, employ category methods. For
example, one can code interruptions or grins; usually, frequencies are used.
Process timing
Behavior on- and offset timestamps. This allows extracting duration, frequency, average
duration, and behavior evolution over time and integrating the behavior with other
timestamped behavior to obtain more complicated indications. For example, time
stamping behavior can reveal whether the doctor interrupts the patient more at the end
of the consultation. Time stamping can also count frequency.
Verbal correspondence
Which nonverbal activity accompanied spoken information? To determine if a doctor
looks at a patient more when asking a lifestyle question than a medical inquiry, you must
code the query and document and analyze gazing at the patient.
In addition, selecting a documenting and analyzing format
is difficult because previous research has shown that various
documenting and analyzing configurations might produce
divergent outcomes in some circumstances. For instance,
there may not be a correlation between gaze duration and
gaze frequency (Hall, 1984, p.78). Choosing the best
documenting and analyzing format for your research
question is crucial. Table 1 shows how to code behavior.
Some micro to macro designs differ. For example, a global
rating of how much eye contact the doctor had with her
patient is less precise than the onset and offset timestamps.
The latter would allow you to code total or average eye
contact, do sequential analyses, and code complex
nonverbal behaviors. The ratio of speaking time spent
looking at the other person to listening time spent looking at
the other person indicates dominance in social interaction.
You must also decide if documenting and analyzing is a
percentage of total interaction. For example, if the excerpts
differ in length, frequency counts may be misleading;
calculate occurrence rates (e.g., smiles per minute).
FORGIVENESS OF ERROR AND PROPENSITY OF
LITIGATION
Higher patient evaluations of trust, empathy, closeness,
and forgiveness, as well as lower patient ratings of
emotional discomfort and avoidance, are strongly
associated with a consistent verbal message in error
disclosure and continual physician nonverbal
involvement. The repair of the error and the continuous
steering of the patient toward the most appropriate
subsequent treatment are two of the essential goals that
should be accomplished after disclosing an error. To
achieve these goals, the patient must have an accurate
awareness of the situation and the capacity to participate
in informed decision-making for follow-up care.
According to Hannawa (2014), the verbal efficacy of
physicians is not a sufficient criterion to attain these goals.
Instead, their nonverbal participation contributes to a
realistic patient self-assessment, enhanced patient
knowledge, and positive behavioral intentions on the part
of the patient. Therefore, nonverbal involvement is an
essential communication skill in the context of error
disclosures. This skill can enable physicians to continue
caring for their patients' physiological well-being and
guide their patients in the direction of corrective follow-up
care that is most appropriate for them.
These criteria are outstanding, but their consequences are
limited for various reasons. First, a recent study partially
confirmed the requirements for adequate error disclosure,
recommending more empirical validations and possible
standard extensions. Most study designs that produced the
criteria depended on patient populations, used correlational
rather than causal data, and lacked theoretical frameworks.
Despite acknowledgment in the communication literature
that emotional messages, medical performance ratings, and
patient satisfaction are connected with physicians'
nonverbal cues, most error disclosure research has only
addressed verbal disclosure contents. According to
communication science research, patients will rely on their
physician's nonverbal responses during disclosure to make
judgments about the error, its implications for their health,
the physician's clinical competence, and their future medical
care. Only concentration on vocal disclosure messages
would generate an incomplete set of error disclosure skills.
There is a correlation between a physician's nonverbal

Research Article ISSN 2313-4747 (Print); ISSN 2313-4755 (Online)
Asian Business Consortium |
AJTP
Page 47
disengagement from an error disclosure and the indication
that the error was of a more severe kind, the attribution of
responsibility to the doctor, and a greater desire to change
physicians (Mazor et al., 2006). The most effective way to
acknowledge apologies is through nonverbal
communication.
EMPATHY CLINICIAN EMOTIONAL CONNECTION
When discussing the relationship between a patient and
their physician, the concept of empathy is frequently
brought up. Irving and Dickson (2004) made the recent
suggestion that empathy should be treated as an attitude.
They brought up the notion that in addition to the
cognitive and emotional elements of empathy, there
should also be a competence dimension (a behavioral
dimension). They went on to point out that the skill
dimension reflects the interpersonal process between
people in expressing empathy. In contrast, the cognitive
and affective dimensions are part of an intrapersonal
process that occurs within a single person experiencing
empathy for another person.
On the other hand, empathy is more of a process involving
activity on the cognitive, affective, and behavioral levels.
Empathy is "the process of comprehending, being aware
of, being sensitive to, and vicariously experiencing the
emotions, thoughts, and experiences of another
individual... without having the emotions, thoughts, and
experiences fully communicated in an objectively explicit
manner," according to one definition found in a dictionary.
Empathy can also be described as "the action of
understanding, being aware of, and being sensitive to, and
vicariously experiencing the feelings, thoughts, and
experience. According to Rogers (1957), having empathy
means "being sensitive, moment-to-moment, to the
changing felt meanings which flow in this other person."
This explanation suggests that empathy is a process that
develops through time in response to the shifting needs of
the target and the environment.
The activity of understanding, being aware of, being
sensitive to, and experiencing the feelings, thoughts, and
experiences of another person, even though one may not
entirely have those same sentiments, ideas, and
experiences oneself, is the action that is referred to as
empathy (Definition of empathy, n.d.). The capacity to
process emotional information about the perception,
assimilation, expression, regulation and management of
one's feelings is what we mean when we talk about
emotional intelligence (EQ). Studies of empathy and
emotional connection consistently show an increased
likelihood of clinician success in practice, increased patient
trust, patient satisfaction, increased adherence to
treatment, and a positive view of providers by patients
(Atreja et al., 2005; Stewart, 1995).
Because empathy is an essential component of good
treatment, doctors must be able to sympathize with their
patients. One must have patience, curiosity, and the
willingness to subject one's mind to the world of the sick to
acquire an acute ability to empathize with others.
However, to achieve their goal of developing empathy,
today's physicians must first overcome a great deal of
resistance. Cynicism, a problematic work atmosphere that
is filled with high responsibilities, and a lack of value
linked to empathy are some of these factors. In addition,
research suggests that many health workers receive
insufficient training and education in compassion and the
emotional components of providing health care to patients.
We think that if physicians had a better understanding of
empathy—and, more importantly, if they framed the
psychological and behavioral activities involved in this
process as acting methods used in emotional labor—they
would be better able to successfully incorporate empathy
into their daily practice.
DISCUSSION
The research evaluated patients' satisfaction levels, trust,
adherence to treatment and preventative service
suggestions, continuity of care, error forgiveness, and
emotional connection using various nonverbal
communication approaches. In the patient-directed model
of clinician-patient interactions, the benefits of nonverbal
communication are abundantly evident from the research
conducted. The level of patient satisfaction is utilized as a
standard indicator of success across the study. Positive
patient quality of healthcare experience is connected with
outcomes such as patient satisfaction, trust, adherence to
treatment and compliance, forgiveness of error, and
emotional connection. These outcomes are associated with
positive patient outcomes. There is no correlation between
the clinician smiling and increased patient trust during the
session. In addition, the results of at least one study
indicate that eye and/or face gaze can hurt the quality of
treatment that a patient receives.
Providers need to be situational awareness of their
nonverbal communication to notice potentially harmful
body language and intentionally alter it. For instance,
specific events, such as seeing a problematic patient,
resolving a patient complaint, or coping with stress, could
generate unfavorable nonverbal reactions. There are many
different approaches to take that can assist medical
professionals in consciously improving their nonverbal
communication. Take, for instance:
 Keep an open, relaxed posture and avoid motions that
suggest unwillingness to listen, disapproval, or
judgment. Encourage the patient to be honest.
 To demonstrate that you are paying attention, simply
nod your head.
 Show interest in the patient's words and avoid
nonverbal movements indicating boredom or
urgency.
 Smiling is encouraged, as is making good eye contact;
nevertheless, you should not stare.

Ekole: Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare Outcome (43-50)
Page 48 American Journal of Trade and Policy ● Vol 9 ● Issue 1/2022
 Take a seat whenever possible, lean forward slightly
to communicate that you are paying attention. Do not
take a condescending position toward the patient by
standing over them and gazing down on them.
Nonverbal messages from technology might frustrate or
alienate patients. For example, electronic health records
(EHRs) can create barriers to patient participation, such as
turning your back on the patient while typing or looking at
the computer during delicate discussions. Educating the
patient about the EHR and the benefits it offers them,
leaving the laptop away during meetings, or using a scribe
to capture the clinical interaction may help.
CONCLUSION AND RECOMMENDATIONS
Achieving accountability and improving performance in
healthcare depends on having a shared goal that unites the
interests of all stakeholders. These goals may vary in
importance for each player, but patient trust and satisfaction
seem familiar to all. Patient satisfaction and trust assessment
are important ways of translating service improvement into
outcomes meaning full to patients, especially longevity and
improved quality of life. Health-related quality of life
(HRQoL) goes beyond direct measures of population health,
life expectancy, and causes of death. It is the impact health
status has on quality of life and health economic savings.
Where health economic savings are the health outcomes
achieved per dollar spent. To achieve a high health-related
quality of life, there is a need to maximize results influencing
this end goal by consciously deciding to fill the current gap
in communication and connection between patients and
clinicians. This gap can be filled by the appropriate
application of various nonverbal styles of communication.
No studies compare the relative importance of one kind of
nonverbal communication over another. From the current
knowledge, applying a combination of styles is better than
none. The recommendation to better prepare clinicians
through training in medical schools, refresher courses, and
sponsored training programs will close this gap. Therefore,
it is recommended that studies focus on each technique of
nonverbal communication and behavior to determine how
each affects the health outcome.
REFERENCES
Atreja, A., Bellam, N., Levy, S. R. (2005). Strategies to
enhance patient adherence: making it simple.
MedGenMed. 7(1).
https://ncbi.nlm.nih.gov/pmc/articles/PMC1681
370/
Blanch-Hartigan, D., Ruben, M. A., Hall, J. A., Mast, M. S.
(2018). Measuring nonverbal behavior in clinical
interactions: A pragmatic guide. Patient Education
and Counseling, 101(12), 2209-2218.
https://doi.org/10.1016/j.pec.2018.08.013
Burcher, P. (2011). Emotional intelligence and empathy: its
relevance in the clinical encounter. Patient
Intelligence, 2011(3), 23-28,
https://doi.org/10.2147/PI.S11070
Caris‐Verhallen, W. M., Kerkstra, A., & Bensing, J. M.
(1999). Non‐verbal behavior in nurse–elderly
patient communication. Journal of Advanced Nursing,
29(4), 808-818. https://doi.org/10.1046/j.1365-
2648.1999.00965.x
Coelho, K. R., & Galan, C. (2012). Physician Cross-Cultural
Nonverbal Communication Skills, Patient
Satisfaction and Health Outcomes in the Physician-
Patient Relationship. International Journal of Family
Medicine, 2012(376907), 1-5.
https://doi.org/10.1155/2012/376907
Cousin, G. & Mast, M. (2014). Chapter: Nonverbal
communication in health settings, In book:
Encyclopedia of Health Communication. Publisher:
Sage.
DiMatteo, M. R., Hays, R. D., & Prince, L. M. (1986).
Relationship of physicians' nonverbal
communication skill to patient satisfaction,
appointment noncompliance, and physician
workload. Health Psychology, 5(6), 581–
594. https://doi.org/10.1037/0278-6133.5.6.581
Griffith, C. H., Wilson, J. F., Langer, S., & Haist, S. A. (2003).
House Staff Nonverbal Communication Skills and
Standardized Patient Satisfaction. Journal of General
Internal Medicine, 18(3), 170-174.
https://doi.org/10.1046/j.1525-1497.2003.10506.x
Hall, J. (1984). Nonverbal Sex Differences: Communication
Accuracy and Expressive Style, Johns Hopkins
Univ. Press, Baltimore.
Hannawa, A. F. (2011). Shedding light on the dark side of
doctor-patient interactions: verbal and nonverbal
messages physicians communicate during error
disclosures. Patient Education and Counseling, 84(3),
344-351. https://doi.org/10.1016/j.pec.2011.04.030
Hannawa, A. F. (2014). Disclosing medical errors to
patients: Effects of nonverbal involvement. Patient
Education and Counseling, 94(3), 310-313.
https://doi.org/10.1016/j.pec.2013.11.007
Irving, P. and Dickson, D. (2004). Empathy: towards a
conceptual framework for health
professionals. International Journal of Health Care
Quality Assurance, 17(4), 212-220.
https://doi.org/10.1108/09526860410541531
Kravitz, R. L. (1998). Patient Satisfaction with Health Care:
Critical Outcome or Trivial Pursuit? Journal of
General Internal Medicine, 13(4), 280-282.
https://doi.org/10.1046/j.1525-1497.1998.00084.x
Manary, M., Boulding, W., Staelin, R., & Glickman, S. W.
(2013). The Patient Experience and Health
Outcomes. The New England Journal of Medicine,
368(3), 201-203.
https://nejm.org/doi/full/10.1056/nejmp1211775

Research Article ISSN 2313-4747 (Print); ISSN 2313-4755 (Online)
Asian Business Consortium |
AJTP
Page 49
Martin, L. R., Williams, S. L., Haskard, K. B., & DiMatteo,
M. R. (2005). The challenge of patient
adherence. Therapeutics and Clinical Risk
Management, 1(3), 189-199.
https://ncbi.nlm.nih.gov/pmc/articles/pmc1661624
Mast, M. S. (2007). On the importance of nonverbal
communication in the physician–patient
interaction. Patient Education and Counseling, 67(3),
315-318. https://doi.org/10.1016/j.pec.2007.03.005
Mast, M.S., Cousin. G. (2013). The role of nonverbal
communication in medical interactions: Empirical
results, theoretical bases, and methodological
issues. In: Martin LR, DiMatteo R. The Oxford
Handbook of Health Communication, Behavior
Change, and Treatment Adherence.
Mazor, K. M., Reed, G. W., Yood, R. A., Fischer, M. A.,
Baril, J. L., & Gurwitz, J. H. (2006). Disclosure of
Medical Errors: What Factors Influence How
Patients Respond? Journal of General Internal
Medicine, 21(7), 704-710.
https://doi.org/10.1111/j.1525-1497.2006.00465.x
Pearson, S. D., & Raeke, L. H. (2000). Patients' Trust in
Physicians: Many Theories, Few Measures, and
Little Data. Journal of General Internal Medicine, 15(7),
509-513. https://doi.org/10.1046%2Fj.1525-
1497.2000.11002.x
Rahman, M. M., Chakraborty, S., Paul, A., Jobayer, A. M.
and Hossain, M. A. (2017). Wheel therapy chair: A
smart system for disabled person with therapy
facility. 2017 International Conference on Electrical,
Computer and Communication Engineering (ECCE),
pp. 630-635,
https://doi.org/10.1109/ECACE.2017.7912981
Rogers, C. R. (1957). The necessary and sufficient
conditions of therapeutic personality
change. Journal of Consulting Psychology, 21(2), 95–
103. https://doi.org/10.1037/h0045357
Stewart, M. (1995). Effective physician-patient
communication and health outcomes: a
review. Canadian Medical Association Journal, 152(9),
1423-1433.
https://ncbi.nlm.nih.gov/pmc/articles/pmc1337906
Thiedke, C. C. (2007). What Do We Really Know About
Patient Satisfaction. Family practice management,
14(1), 33-36.
https://aafp.org/fpm/2007/0100/p33.html
Thom, D. H., Hall, M. A., & Pawlson, L. G. (2004).
Measuring Patients’ Trust In Physicians When
Assessing Quality Of Care. Health Affairs, 23(4), 124-
132. https://doi.org/10.1377/hlthaff.23.4.124
Winnick, S., Lucas, D. O., Hartman, A. L., & Toll, D. (2005).
How do you improve compliance. Pediatrics, 115(6).
https://doi.org/10.1542/peds.2004-1133
Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician
communication and patient adherence to treatment:
a meta-analysis. Medical Care, 47(8), 826-834.
https://doi.org/10.1097%2FMLR.0b013e31819a5acc
--0--

Ekole: Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare Outcome (43-50)
Page 50 American Journal of Trade and Policy ● Vol 9 ● Issue 1/2022
How to cite this article
Ekole, A. (2022). Nonverbal Communication in Clinician-Patient Interaction and Influence on Healthcare
Outcome. American Journal of Trade and Policy, 9(1), 43-50. https://doi.org/10.18034/ajtp.v9i1.619