What Are You Really Saying? The Importance of Nonverbal Cues

By Scott Anders, MD, MBA, CPE, FAAFP
December 5, 2018

It happens to everyone: The words come out, but a different meaning is delivered. Leaders need to understand the nuances of communication when dealing with bosses, employees, peers and patients.

Joe walked into my office with his customary cup of coffee and the usual "good morning." Instantly, I knew something was amiss before turning around to talk. His voice was tighter and his pitch higher. The visual cues were mixed but in general reflected internal conflict or aggression.

His stance was normal. He was not squared off, but he was leaning toward me. While there was a smile on his face, his upper lip was thin and his brows slightly furrowed. Had I taken my cue from his words alone, I would have missed the true meaning of our visit.

It happens to everyone. We hear the words but understand a different meaning than was intended, or believe we are delivering a clear message and see confusion. Nonverbal communication, body language and paralinguistic clues can account for more than 65 percent of human communication.1

During interactions, it has also been estimated that we draw from sight (83 percent), hearing (11 percent), smell (3 percent), touch (2 percent) and taste (1 percent) to understand the message being sent.1

Albert Mehrabian, professor emeritus of psychology at the University of California at Los Angeles, pioneered the 7 percent, 38 percent, 55 percent rule for communication.2 Seven percent is due to the words alone, 38 percent depends upon paralinguistic delivery and 55 percent from facial expressions.

RELATED: What Do You Unknowingly Communicate? Lessons from the Johari Window

Every interaction is interpreted through an internal filter composed of history, past experiences, education, bias, context, culture, expectations and our goals. Perception, which is primarily contextual,3 can affect the message received. Our interpretation and opinions are formed during reception of the message, influenced by delivery and our internal filters. The same interaction, appearance or communication can be and is often interpreted differently in varying circumstances. How many of us have sent an email that is received in a manner not consistent with our intent?

Personal space is widely acknowledged to vary based on culture.4 For example, Americans in general need more personal space than someone from Japan or India. Unless there is a romantic or familiar relationship, standing close to someone in America can be considered an act of aggression, while in another country moving away can be considered inconsiderate.

There are gender nuances in body language as well. When males stand or sit face-to-face, it can be threatening. This may explain the observed phenomenon of males positioning themselves side-by-side or at an angle while interacting with another male. From an early age, females have an inclination for face-to-face positioning during intimate or emotionally intense conversations.

Establishing a Baseline

Unfortunately, there are no definitive or pathognomonic signs. Evaluation of nonverbal cues must be taken in context and compared to that person's baseline mannerism, voice cues and appearance.

Joe Navarro, former FBI counterintelligence special agent and expert on nonverbal cues, emphasizes the importance of establishing a baseline while interviewing potential suspects.5 It is imperative to understand how that person reacts while comfortable to be able to interpret their nonverbal cues when uncomfortable.

Navarro also underlines the importance of our innate limbic response to stress, especially external stressors; freeze, flight or fight (or as he calls them, rigidity, distancing or acrimony). When faced with an uncertain outcome we often resort to one of our three basic responses. How often have you seen someone go absolutely still during a performance review (freeze), lean away from the interviewer (flight), or clench a jaw, narrow their eyes and grip the chair tightly (fight)?

First Impressions 

Some research suggests we form accurate first impressions within 100 milliseconds6 based on nonverbal cues. Negative first impressions can deliver unfavorable biases that may take upward of six months of close contact to reverse.

RELATED: Communicating with Your Care Team: Do You Do It Well?

During first impressions, we quickly and unconsciously assimilate all available information to place this person within our internal catalog, ranking them against our established baselines. What goes into this ranking? Appearance, posture, movements, micro-expressions, eye contact, paralinguistic delivery and contact (shaking hands) to name a few. When you enter a room, do you pause to survey those present upon entering or do you enter with your eyes down, head to the nearest open seat and sit down? Which one conveys confidence? Changing our appearance, our mannerisms and interactions can greatly affect how other people perceive us.


As mentioned before, all nonverbal cues need to be evaluated in the context of delivery. However, in general some cues are often intuitive:

  • Crossed arms— closed off.
  • Thighs crossed away from other participant— lack of interest/confrontation.
  • Thighs crossed toward other participant— interest/friendship.
  • Leaning back— not interested, anxious.
  • Hands steepled— confidence.
  • Hand under chin— thinking/making a decision.
  • Hand on back of neck— not in agreement, has questions.
  • Feet pointed toward the door— flight, desire to flee.
  • Closed mouth/tightened lips— distress, anger.


Up to this point, we have been discussing nonverbal cues as they relate to people, but consider the influence of environmental nonverbal cues. What message is your office, practice or hospital sending?

Consider areas of first contact — websites, geographic location, parking lot and facility appearance. How easy is access and navigation? What is the appearance of your entryway, waiting rooms or guest sitting areas? How does your staff meet and greet arrivals?

RELATED: More Than Words Can Say: How Delivery Affects the Message

How are your patients escorted to their destination and throughout their visit? Do they walk side by side with patients or lead them? What material is offered or provided for reading, education or distraction? How long is the typical wait for service? Are there ostensible signs of empathy for your patients’ concerns, safety and well-being?

Understanding nonverbal cues is essential for leaders to navigate every interaction with direct reports, peers, supervisors, board members and public appearances. Leaders need to be able to convey clear messages, direct reports need to understand the nuances of the messages being delivered, and peers need to feel a sense of equity.

In the end, the only message that matters is the one received. Are you really sending your intended message?

Scott Anders, MD, MBA, CPE, FAAFP, is chief medical officer at Tenet Physician Resources in Dallas, Texas. 


1. Pease A. The Definitive Book of Body Language: How to read other's thoughts by their gestures. Buderim, Australia: Pease International, 2004. 

2. Mehrabian A. Nonverbal Communication. Aldine Transaction, 2007. 

3. Ariely D. Predictably Irrational. New York: HarperCollins Publisher, 2008. 

4. Hall E. (1966). The Hidden Dimension. New York: Anchor Books, 1966. 

5. Navarro J. What Every BODY Is Saying. New York: HarperCollins Publishers, 2008. 

6.Wood P. Snap, Making the Most of First Impressions, Body Language & Chrisma. Novato, CA: New World Library, 2012.

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