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A number of authors note that nonverbal behaviors serve important interpersonal
functions which include demonstrating how individuals feel, as well as providing
clues about their internal physiological state and their intentions (Patterson 2003 ;
Philippot et al. 2003 ). Hall et al. ( 2008 ) note, “In daily life, we are constantly pro-
cessing and evaluating cues that are conveyed by others through the face, body, and
voice or embodied in their appearance, and we can do so with surprising accuracy
based on fairly small amounts of information...” (p. 238). When psychologically
attending to patients, it is important that you attempt to discern the possible reasons
for their actions. For example, a patient may smile as you explain she is at high risk
for a lethal genetic condition. Clearly, she is not happy about this news. Smiling
may be her way of expressing cooperation and politeness.
Psychological attending not only provides a window into another person’s inner
processes, it also conveys your interest and concern (interpersonal sensitivity) and
contributes to genetic counseling outcomes. In health-care settings, research evi-
dence indicates greater physician interpersonal sensitivity is related to higher patient
satisfaction (e.g., Mast 2007 ; Roter et al. 2006 ).
3.1.2 Physical Attending
Physical attending skills involve nonverbal ways in which you use your body to
communicate with patients. They can be more powerful than verbal communica-
tion, because nonverbal communication is constant (Egan 1994 ); much of the mean-
ing of a message may be perceived from nonverbal behaviors. Furthermore, feelings
and thoughts have a way of working themselves into our nonverbals (e.g., looking
down at notes when you feel discomfort, flipping through your notes or the elec-
tronic medical record while the patient is speaking because you disagree with her or
his decision, looking at your watch when you are impatient about the pace with
which the patient is coming to a decision, etc.).
Roter et al. ( 2006 ) assert that in medical visits, “the emotional context of care is
especially related to nonverbal communication and that emotion-related communi-
cation skills, including sending and receiving nonverbal messages and emotional
self-awareness are critical elements of high quality care” (p. S28). They point out
that physicians and patients both show emotions, sometimes even when they attempt
to hide them, and both parties form judgments about each other’s feelings that affect
the processes of care. In genetic counseling, for instance, some patients may be
fearful or uncertain about what is going to happen. They may also believe you are
withholding information or will tell them what to do. They will attempt to read your
nonverbals for any signs of dishonesty, discomfort, disapproval, or judgment.
Good physical attending can alleviate patient apprehension, build rapport, and
facilitate a strong working relationship (e.g., Leach 2005 ; Philippot et al. 2003 ). For
example, Solomon et al. ( 2012 ) interviewed Xhosa-speaking mothers/caregivers of
boys with hemophilia in South Africa. Their data collection methods included an
interpreter who they described as “...empathetic and friendly and established an
3 Listening tofiPatients: Attending Skills