Room Enough for All of Us

• Room Enough for All of Us (142.8 KB)

Mrs. O’Donnell loves Dr. Givens. He’s compassionate, knowledgeable, takes the time to address her concerns, and always gives Peaches a treat. And once, when a late-night encounter with a porcupine left Peaches with a face full of quills, he met her at the clinic. He’s everything a veterinarian should be...except he stands so close!

Members of the veterinary team, consciously or unconsciously, communicate scores of messages to owners and patients during a visit. Personal space, known as proxemics, communicates a great deal. Standing too close or far away can confound the message we want to send. Note the look of extreme discomfort on Mrs. O’Donnell’s face as she leans away to avoid Dr. Givens, who has unknowingly invaded her personal space.

Safety: An Integral Element
One element crucial to successful client communication is perceived safety. Being attentive to the expressions and actions that clients exhibit provides feedback we need to determine whether the person feels “safe.” Applying a knowledge of proxemics can greatly enhance their experience of safety. If an owner seems ill at ease, or appears tense or shifts around the room, recognize and address these expressions of “fight or flight.” While in this agitated state, clients are not receptive to education or instruction. On the other hand, clients communicate feelings of safety and ease through a relaxed stance and steady, comfortable eye contact.Validation signals like head nods throughout a visit are another indicator of safety.

Elements of Proxemics

Vertical distance: Be aware that standing while the owner is sitting can exacerbate a sense of unequal power. Clients may already be uncomfortable in a medical setting and vertical distance can contribute to a feeling of powerlessness.

Horizontal distance: The further away from one another we are during a conversation or discussion, the more disconnected we feel. Attention to this element, without overcompensating by getting too close, ensures clients feel connected and heard.

Angles of facing: When we stand face-to-face with someone, it can feel confrontational or aggressive. Standing side by side, both facing forward, limits eye contact and the exchange of nonverbal cues. Standing at a right angle, however, with you at the head of the table and the client at the 9 or 3 o’clock position, allows for a comfortable personal distance and presents the opportunity to read one another’s facial expressions and gestures.

Personal space: Everyone has an imaginary “bubble” around them that dictates the amount of closeness we feel comfortable with when standing next to another person. Since the circumference of this bubble differs for everyone, be aware of signals from clients that you are standing too close, impinging upon this personal comfort zone.

Proxemics Exercise
Think of the examination room as a “stage.” As you enter, become aware of where you stand in relation to your exam table, your client, and your patient. Does the distance between you and your client feel comfortable? Does he or she appear relaxed and at ease as you talk? Are you able to make eye contact comfortably throughout the history and physical? Becoming aware of these subtle elements of conveying security can pay great dividends in client satisfaction.

Suggested Reading
Nonverbal Communications in Veterinary Practice. Carson C. Vet Clin North Am Small Anim Pract 37:49-63, 2007.