Invest in the beginning | Create rapport quickly | Introduce self to everyone in the room | Establishes a welcoming atmosphere |
Refer to patient by last name
and Mr. and Ms. until a relationship has been established | Allows faster access to real reason for visit |
Increases diagnostic accuracy |
Acknowledge wait | Requires less work |
Make a social comment or ask a non-medical question
to put patient at ease | Minimizes “Oh by the
way…” at the end of visit |
Convey knowledge of patient’s history
by commenting on prior visit or problem |
Consider patient’s cultural
background and use appropriate eye contact and body language | Facilitates negotiating an agenda |
Decreases potential for conflict |
Elicit the patient’s concerns | Start with open-ended questions: | |
“What would you like help with today?” | |
“I understand that you’re
here for … Could you tell me more about that?” | |
Speak directly with patient when using an interpreter | |
Plan the visit with the patient | Repeat concerns back to check understanding | |
Let patient know what to expect: “How about if we
start with talking more about …, then I’ll do
an exam, and then we’ll go over possible tests/ways to
treat this. Sound OK?” | |
Prioritize when necessary: “Let’s make
sure we talk about X and Y. It sounds like you also want to make
sure we cover Z. If we can’t get to the other concerns,
let’s…” | |
Elicit the patient’s perspective | Ask for the patient’s ideas | Assess patient’s point of view: | Respects diversity |
“What do you think might be causing your problem?” | Uncovers hidden concerns and |
“What worries or concerns you most about this problem?” | Diagnostic clues |
“What have you done to treat your illness so far?” | Reveals use of alternative treatments
or requests for tests |
Elicit specific request | Ask about ideas from loved ones or from community |
Explore the impact on the patient’s
life | Determine patient’s goal in seeking
care: “How were you hoping I could help?” | Improves diagnosis of depression and
anxiety |
Check context: “How has the illness
affected your daily activities/work/family?” |
Demonstrate empathy | Be open to the patient’s emotions | Respond in a culturally appropriate
manner to changes in body language and voice tone | Adds depth and meaning |
Builds trust, leading to better diagnostic
information and outcomes |
Make an empathic statement | Look for opportunities to use
brief empathic comments: “You seem really worried.” |
Makes limit-setting or saying “no” easier |
Compliment patient on efforts to address problem |
Convey empathy nonverbally | Use a pause, touch, or facial expression |
Invest in the end | Deliver diagnostic information | Frame diagnosis in terms of patient’s original concerns | Increases potential for collaboration |
Provide education | Explain rationale for tests and treatments | Influences health outcomes |
Review possible side effects and expected course of recovery | Improves adherence |
Discuss options that are consistent
with patient’s lifestyle, cultural values and beliefs | Reduces return calls and visits |
Encourages self care |
Provide resources (eg, written materials) in
patient’s preferred language when possible | |
Involve the patient in making decisions | Discuss treatment goals; express respect towards
alternative healing practices | |
Assess patient’s ability and motivation to carry out plan |
Explore barriers: “What do you think we could do to help overcome any problems you might have with the treatment plan?” |
Test comprehension by asking patient to repeat instructions |
Set limits respectfully: “I can understand how getting that test makes sense to you. From my point of view, since the results won’t help us diagnose
or treat your symptoms, I suggest we consider this instead.” |
Complete the visit | Summarize visit and review next steps | |
Ask for additional questions: “What
questions do you have?” |
Assess satisfaction: “Did you get what
you needed?” |
Close visit in a positive way: “It’s
been nice meeting you. Thanks for coming in.” |