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Listening To Patients With Our Eyes

Discussion in 'Hospital' started by The Good Doctor, Nov 7, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

    Aug 12, 2020
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    In medical school, we are taught to listen to our patients, and if we listen hard enough, they will tell us their diagnosis. The statistic that gets thrown around is that the average amount of time a physician listens before interrupting a patient is 18 seconds. Many of us learn to use motivational interviewing skills to help communicate with our patients. These statistics and methods involve training with our ears and mouths. But what about our eyes?

    Patients communicate immense amounts of information through body language. The primary understood, universal body language is choking. Anywhere in the world you go, if someone is choking, they use both hands to grab their throats. No matter what country you are in or what language is spoken, you can recognize someone choking and provide aid if trained. Body language is also understood to convey various subconscious emotions – crossed arms can be used by someone who is angry, frustrated, or scared, or shutting down in a conversation; open arms and uncrossed legs can be used by individuals who are open to new ideas, and willing to communicate with those they are talking to.


    There are many other physical movements that patients can use that will provide clues to their health and, more specifically, their pain. Similar to what we have been taught in training (listening with our ears and how we ask questions), if we watch patients well enough, they can give us a diagnosis, and more importantly, they can give us information to help treat their pain. The Fascial Distortion Model (FDM) is an osteopathic model that was developed from 1991 to 2006 by Dr. Steven Typaldos, DO. The main distinguishing factor between FDM and other manual and osteopathic models is that it is patient-driven. In this model, the patient is the expert. This is a novel concept, particularly for us as physicians, who have been in training for many years to be considered experts in the human body. This is a humbling model that allows us to step back and trust the patient to communicate information about their own bodies.

    The foundation of this Fascial Distortion Model is learning and interpreting patient body language. Whether a patient sweeps their fingertips across a body part, or pushes multiple fingers into a spot, they are communicating information from their nervous system about how the fascia is behaving. Proprioception is a driving factor in this model; what the patient feels in their movements is shown to us as physicians in a predictable way. This body language can be transformed into a treatment involving a variety of manual manipulation techniques. The outcomes of these treatments are predictable and reproducible, though when they don’t work (is anything really 100 percent effective?), then further pathology can be expected, and additional workup can be utilized. It is possible we can save medical dollars by starting with a simple treatment before jumping to expensive testing to determine the causes of pain.

    Diagnosis and treatment in the FDM can be a quick addition to any practice. This model can be useful for both acute and chronic pain. Patients who have been through years of procedures, medication regimens, with little to no success, could benefit from being listened to in another way. Whether or not you choose to incorporate the manual techniques might be individually driven for your own practice. Suppose you can learn to identify these body languages and movement patterns in the FDM. In that case, you can either utilize techniques yourself (only an additional couple of minutes to a patient appointment) or send your patient to someone who practices these techniques, for what can be a life-changing (and practice-changing) treatment. Incorporating this into your practice is mainly learning how to observe your patients in a way that you have not looked at them before – with your eyes. The body language is already there. You just need to know what to look for.


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