Habit | Skills | Techniques & Examples | Pay-off | ||||
---|---|---|---|---|---|---|---|
Invest in the beginning | Create rapport quickly | • Introduce self to everyone in the room • Acknowledge wait • Convey knowledge of patient's history by commenting on prior visit or problem • Attend to patient's comfort • Make a social comment or ask a non-medical question to put patient at ease • Adapt own language, pace, and posture in response to patient | • Establishes a welcoming atmosphere • Allows faster access to real reason for visit • Increases diagnostic accuracy • Requires less work • Minimizes "Oh, by the way..." at the end of the visit • Facilitates negotiating an agenda | ||||
 | Elicit the patient's concerns | • Start with open-ended questions: - "What would you like help with today?" or, - "I understand you're here for... Could you tell me more about that?" or, - What else?" • Speak directly with the 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, lets..." |  | ||||
Elicit the patient's perspective | Ask for patient's ideas | • Assess patient's point of view: - "What do you think is causing your symptoms?" - "What worries you most about this problem?" • Ask about ideas from significant others | • Respects diversity • Allows patient to provide important diagnostic clues • Uncovers hidden concerns • Reveals use of alternative treatments or requests for tests • Improves diagnosis depression and anxiety | ||||
 | Elicit specific requests | • Determine patient's goal in seeking care: "When you've been thinking about this visit, 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, or family?" |  | ||||
Demonstrate empathy | Be open to patient's emotions | • Assess changes in body language and voice tone • Look for opportunities to use brief empathic comments or gestures | • Adds depth and meaning to the visit • Builds trust, leading to better diagnostic information, adherence, and outcomes | ||||
 | Make at least one empathic statement | • Name a likely emotion: "That sounds really upsetting." • Compliment patients on efforts to address problem | • Makes limit-setting or saying "no" easier | ||||
 | Be aware of your own reactions | • Use own emotional response as a clue to what patient might be feeling • Take a brief break if necessary |  | ||||
Invest in the end | Deliver diagnostic information | • Frame diagnosis in terms of patient's original concerns • Test patient's comprehension • Improves adherence | • Increases potential for collaboration • Influences health outcomes • Improves adherence • Reduces return calls and visits | ||||
 | Provide education | • Explain rationale for tests and treatments • Review possible side effects and expected course of recovery • Recommend lifestyle changes • Provide written materials and refer to other sources | Encourages self care | ||||
 | Involve patient in decision making | • Discuss treatment goals • Explore options, listening for the patient's preferences • 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." • Assess patient's ability and motivation to carry out plan |  | ||||
 | Complete the visit | • Ask for additional questions: "What questions do you have?" • Assess satisfaction: "Did you get what you needed?" • Reassure patient of ongoing care |  |