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How your nonverbal cues may be choking your practice


If you want to become a better communicator, it’s important to become more sensitive not only to the body language and nonverbal cues of others, but also to your own.

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Donna Suter, president of Suter Consulting Group. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

“Talk low, talk slow, and don’t talk too much.”  John Wayne

Howdy Pilgrim!

When was the last time you watched a John Wayne movie? A lot of communication truths are clearly illustrated in those Westerns starring a young John Wayne. Wayne rose to stardom in action movies (mostly Westerns) as a slow talking cowboy that the town could trust to do the right thing.

In your relationships with people at work, you may have to correct their behavior, postpone listening during clinic hours, or in some way disappoint them. To avoid unintentionally creating misunderstandings, become more aware of the unspoken messages you are sending to others. Effectively leading a busy eyecare team while delivering eye health and visual acuity recommendations to nervous patients mean understanding how your message is shaped by your feelings or attitudes.1

Body language and tone of voice are as important as the words you speak. There is an oft-quoted study by Albert Mehrabian on how people decide whether they like one another.

Simply put, employees don’t stay in the employment of a doctor they do not like and patients will seldom return for follow-up care. Your ‘first impression’ is the sum of the following:

  •      7% spoken words

  •      38% voice tone

  •      55% general body language

So what did a successful actor like John Wayne know that we would do well to apply in our offices?

  •      It's not just words: a lot of communication comes through nonverbal means.

  •      Without seeing and hearing nonverbals, it is easier to misunderstand the words.

  •      When we are unsure about what the words mean, we pay more attention to the nonverbals.

The percentages are subject to change. People (employees and patients) pay more attention to the non-verbal indicators when they trust the person less and suspect deception. It is also generally understood that voice tone and body language are harder to control than words.

Doctors who exemplify this


The following fictitious doctors are all articulate practitioners who say one thing while communicating something else nonverbally, with disastrous results:

  • Dr. Black believes he is admired by patients and gets along great with employees in the office, but if you were to ask any of them, they would say that Dr. Black is "intimidating" and "very intense." Rather than just looking at you, he seems to devour you with his eyes. And if he takes a patient’s hand, he lunges to get it and then squeezes so hard that it is uncomfortable. Dr. Black is a caring guy who wishes he had more patients and a stronger work-team, but his nonverbal awkwardness keeps people at a distance and limits his ability to grow his practice.
  • Dr. Smith has no problem meeting people, but she has a difficult time keeping employees longer than a few months. Dr. Smith is funny and interesting, but even though she constantly laughs and smiles, she radiates tension. Her shoulders and eyebrows are noticeably raised, her voice is shrill, and her body is stiff. Being around Dr. Smith makes many patients feel uncomfortable and the percentage of established patients returning regularly for care is well below the industry benchmark. Dr. Smith has a lot going for her that is undercut by the discomfort she evokes in others.
  • Dr. Brown thought he found the perfect practice to buy into when he met the founding partner, but the owner wasn't so sure. Dr. Brown is hard working and a smooth talker, but seems to care more about his thoughts than those of the more senior staff members. When the lead tech has something to say, Dr. Brown is always ready with wild eyes and a rebuttal before she can finish her thought. This defensiveness makes the staff feel ignored and this once stable team is now a revolving door of new employee after new employee. He loses out with patients for the same reason. His inability to listen to others makes him unpopular with many of the patients the partners hired him to see.

Evaluating nonverbal signs



Evaluating nonverbal signals2

Eye contact

Is eye contact being made? If so, is it overly intense or just right?

Facial expression

What is their face showing? Is it mask-like and unexpressive, or emotionally present, genuine, and filled with interest?

Tone of voice

Does their voice project warmth, confidence, and interest, or is it strained and blocked?

Posture and gesture

Are their bodies relaxed or stiff and immobile? Are shoulders tense and raised, or slightly sloped?


Is there any physical contact? Is it appropriate to the situation? Does it make you feel uncomfortable?


Do they seem flat, cool, and disinterested, or over-the-top and melodramatic?

Timing and pace

Is there an easy flow of information back and forth? Do nonverbal responses come too quickly or too slowly?


Do you hear sounds that indicate caring or concern?


It is almost impossible not to communicate. Albert Mehrabian never claimed that words weren’t important. The way you listen, look, move, and react tells the other person whether or not you care, if you’re being truthful, and how well you’re listening. When your nonverbal signals match up with the words you’re saying, they increase trust, clarity, and rapport. When they don’t, they generate tension, mistrust, and confusion.

Becoming a better communicator


If you want to become a better communicator, it’s important to become more sensitive not only to the body language and nonverbal cues of others, but also to your own. Start by trying to imitate John Wayne at his best. During the latter half of the 1940s, Wayne was cast as Captain Kirby York  in what many film fans and critics regard as being among his finest work, notably the "cavalry trilogy" (Fort ApacheShe Wore a Yellow Ribbon, and Rio Grande)

Wayne pulled it off because the audience believed he was a cowboy. Will your employees and patients believe you in the starring role of a good communicator? Just like an actor in the movies, it's our nonverbal communication-our facial expressions, gestures, eye contact, posture, and tone of voice-that speak the loudest.

The ability to understand and use nonverbal communication, or body language, is a powerful tool that can help you connect with others, express what you really mean, and build better relationships. As you begin to pay attention to the nonverbal cues you give and receive, your ability to grow your practice will improve.

 Happy Communicating, Little Pilgrim!




1. Mehrabian, A. and Wiener, M. (1967). Decoding of inconsistent communications, Journal of Personality and Social Psychology, 6, 109-114

Mehrabian, A., and Ferris, S.R. (1967), Inference of Attitudes from Nonverbal Communication in Two Channels, Journal of Consulting Psychology, 31, 3, 48-258

Mehrabian, A. (1971). Silent messages, Wadsworth, California: Belmont

Mehrabian, A. (1972). Nonverbal communication. Aldine-Atherton, Illinois: Chicago

2. Black, Smith and Brown scenarios modified from information and the evaluating nonverbal signals table source. http://www.helpguide.org/articles/relationships/nonverbal-communication.htm



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