The Importance of Nonverbal Communication in Patients of Other Cultures By Rebecca Jackson, CMOM, AHI, CBCS Reading a patient`s body language is more complex when the patient is from another country or has a different background. In order to effectively communicate with multicultural patients, the medical team has to learn how to watch nonverbal signs. One has to not only hear the words being spoken, but also read the body language, to understand the true meaning of the patient`s words. If listening is not done properly, misunderstandings and assumptions could occur that damage the practice`s relationship with that patient. When greeting a patient from a different culture, be aware that they may want to greet you in a different style then what you are accustom to here in American. For example, in Italy and France, patients may want to kiss one or both cheeks when meeting someone new. In Japan the patient may want to bow at the waist. Patients from northern Europe may only shake your hand with one pump, but patients from southern Europe may want to shake longer and warmer! In Turkey, too firm a handshake is rude, and in certain African countries a limp handshake is the norm. Plus certain cultures never have a man and woman shake hands. Touching in general, like shaking hands, should be done with caution. Also watch gestures with hands. In America we give high fives, thumbs up, and the `a-ok` sign on a daily basis. But in Russia, touching the pointer finger and thumb together represents a gesture for the anus, a gigantic insult to a Russian patient! In Greece, a thumbs up indicates the phrase `up yours`. Personal space should always be respected. Start the conversation at a larger space then what you would in American, just to be safe, and let the patient come into your zone. Personal space is different for everyone, so remember: getting that close is only for the length of that conversation! Grin and bear the uncomfortable closeness. It will strengthen the bond the medical professional will develop with that patient. Patients who feel comfortable will communicate more effectively, which is the ultimate goal in every encounter. Speaking of bearing uncomfortable situations, there are wide variances with personal hygiene in other cultures. Some cultures do not wear deodorant, brush teeth, or clean as frequently as others. There are Middle Eastern countries where perfume is used extensively to mask body odors. The perfume is not mean to be offensive but it may come across as such. Do not point out women who have not shaved their legs or underarms, or men who have not ever shaved their beards. These are examples of how other cultures view body hair. The final issue of cultural body language is eye contact. How and when to make eye contact can be appropriate or inappropriate, and it is a useful method of communication. In Germany and Spain, eye contact customs are similar to those in the United States. Eye contact with a stranger in France invites them over, as you find them interesting. In Asian, African, and Latin American cultures, making extended eye contact is seen as challenging and trying to assert dominance. In Middle Eastern cultures, eye contact between men and women is not appropriate. Avoiding eye contact can be seen as submissive or polite or respectful of the other person`s authority. So keep eye contact brief (4-5 seconds) and direct; blink as necessary; move the head occasionally so you do not seem frozen. All these tips will help support communication with the multicultural patient. Listening is an important soft skill that is difficult to teach. It must be learned through interaction, trial and error, and practice! Give your multicultural patient your full attention and look for the message in the patient`s body language as well. Do not try to rush the patient or lose focus on the conversation. With education, you will become culturally confident, respectful, and a better medical professional.  Sources used: http://womeninbusiness.about.com/od/businessetiquette/a/making-eye-contact_3.htm http://blogs.hbr.org/cs/2011/03/shhh_listening_is_critical_in.html http://www.directhit.com/ansres/Cultural-Differences-in-Body-Language-Communication.html http://www.samdiener.com/2009/10/body-language-in-different-cultures/ http://eliothoppe.com/articles/20080108-body_language.html