One Step Beyond Eye Contact

Jan Chozen Bays, MD, is a pediatrician, respected Zen teacher, and bestselling author of Mindfulness on the Go. Her new book, Mindful Medicine: 40 Simple Practices to Help Healthcare Professionals Heal Burnout and Reconnect to Purpose, is written with healthcare professionals in mind, but is of great interest to anyone looking to deepen their mindfulness of body. This adapted excerpt provides healthcare workers (and the curious) a way to connect with other people by noticing the fine details of their being.

The Practice

Notice your patients’ eye color. Note: This involves directly looking at them while talking to them. Record their eye color in their chart. In addition to blue or brown, notice different shades of gray, green, or gold. At the same time, you could take note of any vertical earlobe creases.

Discoveries

We medical professionals are often in a hurry, preoccupied with the busyness of getting through a patient visit and on to the next. We look at the computer as we enter data in the e-chart or as we scribble notes, asking patients questions as we continue to type or write.

It is impossible to pay full attention to two things at once. Prove this yourself with a simple experiment.

Close your eyes and bring full awareness to your right big toe. Notice all the sensations that tell you that you have a big toe: temperature, tingling, touch, pressure.

Now move your full attention to your left earlobe. Since you cannot see it, how do you know you have an earlobe? Be aware of all the sensations: temperature, tingling, touch, pressure.

Now pay full attention to both your right big toe and your left earlobe. What do you notice? Can you pay full attention to both? Or is your attention weakened, divided, or fluctuating, flitting back and forth?

We have to acknowledge that we cannot pay full attention to a patient while entering data into a computer. We’ve all had conversations with someone who was distracted, who was cracking their knuckles or neck or moving their eyes away to look over our shoulder.

It’s frustrating, especially if the conversation is important to you, like a conversation about your worrisome physical symptoms or upcoming surgery.

A review of literature on bedside manner found that relationship-focused training, which included maintaining eye contact, had a small but statistically significant effect on the specific health outcomes in patients with obesity, diabetes, asthma, or osteoarthritis. It could affect weight loss, blood pressure, blood sugar, lipid levels, and pain. Interestingly, the researchers noted that the impact was greater than the reported effects of low-dose aspirin or cholesterol-lowering statins for preventing heart attack.

What do we know about eye color? Eye color is determined by a number of genes, not a single gene as we might have learned in biology classes. Any combination of parent-child eye color is possible. There is no blue or green pigment in blue or green eyes; those colors are due to light scattering, similar to the cause of the apparent blue color of the sky.

Eye color ranges from light blue to dark brown. Scientists believe that originally all humans had brown eyes; blue eyes may be the result of one mutation that occurred only six to ten thousand years ago. Blue eyes are found in just 8–10 percent of people in the world and are becoming less common. Eye color is also related to a higher risk of having a number of diseases. Blue-eyed people have a higher risk of type 1 diabetes, hearing loss, melanoma, infiltrating endotheliosis, and age-related macular degeneration, but have higher pain tolerance in labor.

Brown-eyed people are more likely to develop vitiligo and cataracts. One study found that blue-eyed people are more likely to drink alcohol, drink larger amounts, and have a higher risk of developing alcoholism. Heterochromia, two different eye colors in the same person, can be a familial trait, or the result of chimerism—having two complete sets of DNA. If heterochromia appears late in life, it can be a sign of disease such as pigmented glaucoma or neurofibromatosis. If you notice heterochromia in an infant or if one eye changes color later in life, a medical workup and a referral to an ophthalmologist are warranted.

You might comment on positive aspects of this research to a patient, saying something like, “I notice you have blue eyes. Did you know that blue-eyed people are less susceptible to cataracts?” Or, for a brown-eyed person, “Did you know that brown-eyed people seem to be less likely to get into trouble with alcohol?” We can educate people in informal as well as formal ways.

Deeper Lessons

We look at rashes and moles, in ears and down throats, at nail beds and clubbing, we check mouths for tongue cancer and dental caries, and we might use the ophthalmoscope to check for pupillary reflexes and papilledema, but we don’t often look patients directly in the eye, human being to human being.

Many of our patients live relatively lonely lives. Our connection with them might be the only warm interaction of their day. Research shows that when physicians make eye contact with patients during a visit, patients rate the physician as more empathic and are more satisfied with their care. The effect of eye contact will increase the patient’s empathy rating for the doctor even when the length of the visit is short.

Making eye contact in healthcare is not without complexity; looking into another person’s eyes may make us uncomfortable because it seems too intimate. Women may develop a tendency to watch people’s mouths as they talk, rather than look into their eyes. This is a protective habit, formed to prevent men from misinterpreting direct gaze as an invitation. There are cultural differences, too. In some cultures, particularly Muslim or Asian, women are often taught not to have direct eye contact with men.

In other cultures, maintaining eye contact can be seen as a sign of self-confidence. Direct eye contact can confer feelings of honesty and sincerity, but prolonged eye contact may be seen as exerting power or sexual interest. However, in Asian, African, Native American, or Latin American cultures prolonged direct eye contact can signal disrespect or even anger.

Healthcare providers may be hesitant to look directly into the eyes of their patients, for fear of misinterpretation of those actions as sexual interest or concern about triggering reactions related to past trauma. This is an area where we need to be sensitive, but not tip over into being cold and overly formal.

I’ve found that I learn a lot about how to behave as a physician when I am on the other side—as a patient. My primary care physician always sits at my level and looks me in the eye as we begin conversing at the start of the visit, and it makes me feel more connected, more trusting, and open to telling her all my concerns. It’s a small difference, but one I notice every time I see her. Her warm but gentle handshake at the beginning or end of our visit is also quite effective.

Final Words

When we are busy, it’s all too easy to begin objectifying patients. And, by association, ourselves. A few moments of connecting, by looking into their eyes as you greet them and asking about their concerns, can make a big difference to both of you.

From Mindful Medicine: 40 Simple Practices to Help Healthcare Professionals Heal Burnout and Reconnect to Purpose by Jan Chozen Bays © 2022 by Jan Chozen Bays. Reprinted in arrangement with Shambhala Publications, Inc. Boulder, CO www.shambhala.com

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