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.

To Help Doctors and Patients, Researchers Are Developing a 'Vocabulary of Pain'

To Help Doctors and Patients, Researchers Are Developing a


'Vocabulary of Pain'


ScienceDaily (July 27, 2011) — All over the world, patients with chronic pain struggle to express how they feel to the doctors and health-care providers who are trying to understand and treat them.

Now, a University at Buffalo psychiatrist is attempting to help patients suffering from chronic pain and their doctors by drawing on ontology, the branch of philosophy concerned with the nature of being or existence.

The research will be discussed during a tutorial he will give at the International Conference on Biomedical Ontology, sponsored by UB, that will be held in Buffalo July 26-30.

"Pain research is very difficult because nothing allows the physician to see the patient's pain directly," says Werner Ceusters, MD, professor of psychiatry in UB's School of Medicine and Biomedical Sciences, and principal investigator on a new National Institutes of Health grant, An Ontology for Pain and Related Disability, Mental Health and Quality of Life.

"The patient has to describe what he or she is feeling."

That is a serious shortcoming, Ceusters says, because each patient's subjective experience of pain is different. Descriptions of pain therefore lack the precision and specificity that is taken for granted with other disorders, where biomarkers or physiological indicators reveal what health-care providers need in order to assess the severity of a particular disorder.

"If we want to more effectively help people suffering from chronic pain, we need to study a population that is consistent, patients who have features in common," Ceusters says. "The problem with pain is, it's very hard to build up a group with the same sort of pain. People don't have the same vocabulary or linguistic capabilities or even the same cultural backgrounds. It's something pain researchers have struggled with for decades," Ceusters says. "We need to develop a vocabulary of pain."

That's where ontology comes in.

"The philosophical definition of ontology is the study of things that exist and how they relate to each other," says Ceusters, who also is director of the Ontology Research Group of UB's New York State Center of Excellence in Bioinformatics and Life Sciences. "I am a person and you are a person so we share something. Suppose I drop dead. What lies on the floor? Is that still a person? If it is no longer a person, is it still the very same thing that was sitting here as a person but now is a corpse?"

Ceusters says that in much the same way, definitions of pain and especially of chronic pain need to be much more precise; ontology provides methods of distinguishing among categories and describing data in uniform and formal ways.

While the philosophical approach to ontology naturally has its roots in ancient Greece, a computational approach to ontology began in the latter part of the 20th century, when computer scientists interested in artificial intelligence wanted to create software programs that perform reasoning they way humans do. To do so, they began to draw on ontology.

"Here at the University at Buffalo, we excel at combining the two approaches; we have a very strong foundation in the philosophical approach to ontology with Barry Smith, who is a pioneer in contemporary ontology, especially related to biomedical applications," says Ceusters, "while we also have a very strong presence in computational approaches, especially to biomedical ontology. These computational approaches allow us to devise systems of communication in which there is a consistent meaning for terms used in different language systems and conceptual frameworks."

With the $793,571 NIH grant, Ceusters and colleagues will study data gathered from thousands of patients in the U.S., the United Kingdom, Sweden, Israel and Germany who suffer from oral and facial pain, including temporomandibular disorder (TMD).

Ceusters will work with his colleagues, including Richard Ohrbach, DDS, PhD, associate professor of oral diagnostic sciences in the UB School of Dental Medicine, to develop an ontology that allows the data to be described in a much more uniform way.

"The goal is to integrate the data together so that we have a large pool of data that will allow us to obtain better insight into the complexity of pain disorders, specifically the assessment of pain disorders and how they impact mental health and a patients' quality of life," Ceusters says.

The grant will build on past work that Ceusters conducted with a grant from the Oishei Foundation related to improving the classification, diagnosis and treatment of psychiatric conditions.

Ceusters, who has degrees in knowledge engineering and information science as well as in neuropsychiatry, says that the current effort grew out of his work on that grant and also from a meeting with pain researchers that he attended in 2009.

"At that meeting, we discussed how we might build an ontology so that it could represent what pain is and how it relates to body parts and their activities and functions," he says. "Our goal is to create a software program that will allow all pain specialists to express themselves in crystal clear terms," he says, "We will create a symptom checklist that can be understood by computers. We have to define the terminology of pain. This can only be solved by the kind of ontology we are doing here at the University at Buffalo.

How Best To Treat Chronic Pain? The Jury Is Still Out

A review of recent studies on pain medicine appearing in the June 2008 issue of the Journal of General of Internal Medicine reports that while various approaches and combinations of therapies to treat pain have advantages and disadvantages, researchers don't yet know how to determine which is best for individual patients.

Among the approaches to pain management studied were those relying on the prescription of opioids (drugs such as morphine, Percocet and Vicodin), surgery, and alternative medicine (acupuncture, herbal remedies).

"We conducted this review of pain management strategies because doctors, especially primary care doctors who manage the bulk of patients with chronic pain, are frustrated and want to know how to better alleviate what is often debilitating pain. Many of these physicians have not been well trained in pain management. And while many are paying more attention to pain than ever before, especially given JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and Veteran Affairs mandates that pain be regarded as the --fifth vital sign,-- they don't know what treatment will work for a given patient. They want guidance and we found very limited information," said the paper's senior author, Matthew J. Bair, M.D. Dr. Bair is an assistant professor of medicine at the Indiana University School of Medicine, a research scientist with the Regenstrief Institute, Inc. and an investigator at the Roudebush VA Center of Excellence for Implementing Evidence Based Practice.

Chronic or recurrent pain affects more than 75 million Americans.

"We have found that there are huge gaps in our knowledge base. For example, none of the opioid research trials lasted longer than four months, a small fraction of the time during which many chronic sufferers typically experience pain and are prescribed this potent class of medication," said Dr. Bair. "Similarly there were insufficient trials of herbal remedies versus other analgesics (i.e. pain medicines), in spite of the fact that pain management is one of the major reasons for the use of alternative medicine."

Dr. Bair's own research focuses on understanding the interface between affective disorders such as depression and anxiety and chronic pain and developing strategies to improve pain management in the primary care setting.

DIC's Alliance Medical eyes fresh funds

Alliance Medical, a leading British diagnostic imaging company majority owned by Dubai International Capital (DIC), is looking for 150 million pounds ($244 million) in fresh funds for its expansion, the UK's Telegraph newspaper reported on its website late on Saturday.

DIC bought Alliance in November 2007 for 600 million pounds from British private equity firm Bridgepoint, which had previously paid 111 million pounds for a stake in 2001 and still has shares in the company, the newspaper said.

Both DIC and Bridgepoint “are likely to put fresh equity into the business as part of the fundraising process”, Telegraph reported, citing unnamed sources.

"In line with its business plan and previous approach, Alliance Medical is exploring a range of options to finance growth. As with all previous ventures, the move will involve both debt and equity,” a company spokesperson was quoted as saying.

Alliance is one of several British companies bought by Dubai entities part of the investment portfolio of Dubai’s ruler Sheikh Mohammed bin Rashid al-Maktoum before the global credit crisis.

DIC’s investments in the UK include ownership of budget hotel chain Travelodge and engineering firm Doncasters.