Some tips from Professional practice and reading some key texts (see References)
- Rapport building is not an exact science, it is part of the ‘Art’ of Medicine.
- Part of the joy of the practice of Medicine is working out your own approach and adapting it to this patient in front of you.
- Established doctors have a style that is largely consistent over time.
- Self-awareness is key to ensuring your style is effective and being able to adapt it when needed. ²
- It is worth working out your approach as history taking is a key step in the majority of diagnoses. ¹
- Trust makes consultations more enjoyable for both parties and can give a ‘lever’ for your words/advice to have more impact.
- This article will not explore ICE, cues etc in detail. You can read this elsewhere.
- You are two humans having a professional conversation.
- It is like in any other friendly interaction.
- Check whether the patient is comfortable. ¹
Set Professional Boundaries
- Attire – dress appropriately, wear your name badge, demonstrate appropriate hygiene (e.g. bare to elbows in hospital settings)
- Introduce yourself and explain your role – ‘Hi, I am Dr Smith…’
- Explain why you are here – ‘I am here to discuss x if that’s OK.’
- Consent – if the patient does not agree to the consultation, stop and discuss with your senior
- Confidentiality – what the patient tells you will be confidential – unless there is a risk to them or others noted
- If information will be shared with others (e.g. within the healthcare team, tell the patient at the outset)
- Expectations of time – e.g. ‘We have 10 minutes, but if there is anything we don’t cover, we can cover it next time.’
- Be honest
- Be yourself – just the professional version of you!
- The patient has social skills; these will detect if you are being authentic.
- If you are, they are more likely to trust you.
Stop and Notice
- What is the patient actually communicating with verbal and non-verbal cues?
- The first thing the patient says is usually the only thing they have full control over (after this point they are often responding to the doctor).
- Often they have rehearsed this intro in the waiting room.
- Unguarded remarks as they enter. More likely to say this if the doctor says less.
Engage the Patient
- e.g. What questions did you have? (allow time for them to answer, keeping an eye on time)
- e.g. ‘Yes’, ‘mmm’ when appropriate
- Nod – when appropriate
- If they share sad news – acknowledge this – ‘I’m sorry to hear that’. Consider if this is relevant to the rest of the history and address as appropriate (for example in a Mental Health history)
- Their words back to them at an appropriate juncture (Chunking and Checking ³).
- I have included this here as this also is a way to demonstrate you have been listening.
Open Body Language
- Face the patient – Look at their face when they speak (learn to touch type or write without looking down – or signpost – ‘ I am just going to note this down’ so they understand why you are looking at something else)
- Show genuine interest – Find one thing you genuinely like about them – even if it is only their socks!
Coaching Style Questions
- Try adding a Coaching style question where appropriate – e.g. Lifestyle issues like smoking cessation, weight loss
- ‘What are the barriers in your view?’
- ‘How much do you want to change?’ (Scale of 1-10)
- ‘How easy do you think it will be to change?’ (Scale of 1-10)
- ‘What thoughts have you had about what you could do to improve your situation’
- “What have you tried and what has worked?’
Aid the Patient’s Retention
- Often patients find it hard to retain what you have said as they find the consultation emotionally charged.
- Also, they may not be feeling too well!
- Help them recall the key points:
- Repeat the key points in a summary at the end
- Ask them to repeat back a few key points
- Invite them to take notes if they would like to
- Give them written material to take away
- Signpost them to good resources for follow on reading – written/websites/apps etc
- Make sure you are happy with the content of these before recommending.
- Reassure them that if they think of a question later on, they can have it addressed by (contacting you/your colleague/the ward/bring the question to the follow-up appointment etc).
Look after yourself
- Often consultations contain distressing information exchange. Be aware of you how you feel and seek help for yourself if needed.
Finally – Be Kind
- This is vastly underrated and key to positive human interactions.
- Be kind to your patient and kind to yourself.
- The Oxford Handbook of Clinical Medicine. 6th Ed; Longmore, Wilkinson, Rajapjpalan: p34.
- The New Consultation, Developing Doctor-Patient Communication. Pendleton, Schofield, Tate, Havelock: p41