While a good deal has been written about the importance of effective communication in health care, I am not sure we pay enough attention to the nonverbal aspects of communication. The mood and foundation for the rest of the visit is established in the first 30 seconds, and if we cannot communicate professionalism, kindness, trustworthiness and compassion quickly, we're not likely to repair the lapse.

Our appearance does a lot to frame expectations. Wear a newly laundered and pressed white coat, and you will both meet OSHA standards and reassure the patient that professionalism is important in all aspects of your practice. Wear tennis shoes, jeans and a casual shirt, on the other hand, and you'll suggest that the patient may be interfering with your recreational pursuits. You earned a medical degree, not a license to ignore common courtesy or professionalism. Should physicians not look at least as professional as lawyers, accountants, chiropractors or store managers?

Honing and using good interpersonal skills, of course, is crucial to effective communication. We need to be able to explain complex treatment plans in simple messages delivered in ways the patient will accept. But here, too, nonverbal aspects of communication may tend to be slighted. Cordiality in particular may be underrated as a communication “skill.” Napoleon Hill, the great 20th century lecturer on communication and success, suggested that professionals treat everyone as if he were a rich uncle who might be leaving them something in his will. A warmhearted professional is most pleasing to patients and gives added value to their office experiences. Remember that our patients hire and fire us at every visit and high quality “customer service” is required from all for all.