Habit | Skills | Techniques and examples |
Invest in the beginning | Create rapport quickly | Introduce yourself to everyone in the room Make a social comment or ask a nonmedical question to put the patient at ease Convey knowledge of the patient's history by commenting on a prior visit or problem Consider the patient's cultural background and use appropriate eye contact and body language |
Elicit the patient's concerns | Start with open-ended questions: “I understand that you're here for… Could you tell me more about that?” | |
Plan the visit with the patient | Repeat concerns back to check understanding Let the patient know what to expect: “How about if we start with talking about…, then I'll do an exam, and then we'll go over possible tests/ways to treat this. Sound OK?” Prioritise 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 the patient's point of view: “What concerns you most about this problem?” “What have you done to treat your illness so far?” Ask about ideas from loved ones or the community |
Elicit specific request | Determine the patient's goal in seeking care: “How were you hoping I could help?” | |
Explore the impact on the patient's life | 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 or voice tone |
Make an empathetic statement | Look for opportunities to use brief empathic comments: “You seem really worried.” Compliment the patient on their efforts to address the problem | |
Convey empathy nonverbally | Use a pause, touch or facial expression | |
Invest in the end | Deliver diagnostic information | Frame the diagnosis in terms of the patient's original concerns |
Provide education | Explain the rationale for tests Explain treatments and possible side-effects of therapy Discuss options that are consistent with the patient's lifestyle, cultural values and beliefs Provide resources in the patient's preferred language when possible | |
Involve the patient in making decisions | Discuss treatment goals Assess the patient's ability and motivation to carry out the proposed 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 the 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 treat your condition, I suggest we consider this instead.” | |
Complete the visit | Summarise the visit and review next steps Ask for additional questions Close the visit in a positive way: “It's been nice meeting you.” |
Reproduced and modified from [33] with permission.