1
section
h e a d
mind
your
manner
Using effective communication during a
consultation can help patients feel more at ease
and better informed. Chris Oliver offers some tips
to improve communication skills at the bedside
The first impression is very important. Most patients
will form an opinion of the surgeon within the
first few seconds, so smart dress and a smile are
essential. Try to have a slight forward lean to be
closer to the patient. Eye contact is vital to help
connect with the patient, but try to avoid staring.
A simple ‘good morning’ or ‘good afternoon’ is a
fine starting point. Check that you know the correct
pronunciation of the patient’s name, as getting it
wrong is embarrassing. I think it’s better to say,
‘I’m a doctor’, as most patients still do not realise
the significance of surgeons in the United Kingdom
being called Mister/Mrs. If possible, sit down and
make a normalising comment such as, ‘the weather
is very nice today.’ Try not to stand if the patient is
seated. Sit with an open posture and avoid yawning,
staring out the window or tapping your pen.
surgeonsnews
july 2004
vol 3 - issue 3

2
section
head
Making the patient comfortable emotionally takes a background. It is worthwhile using simple drawings
considerable amount of skill. Most surgeons do not and appropriate analogies. I once worked with a
allow the patient to talk for more than 30 seconds surgeon who drew diagrams on the pillowcase but
without interrupting. One of the best introductions this did rather upset matron. I have a lot of patient
is to say, ‘how can I help you?’ Use open-ended information on my website and I will often direct
questions and give the patient a chance to reply. Try patients to that providing they have Internet access.
to assimilate the data, information and knowledge (www.rcsed.ac.uk/fellows/cwoliver/)
as the patient tells you their story. Many will have
other problems, so allow the patient to discuss
these early so as to organise clinical priority in ‘Asking patients if they are happy
the interview. Repeating back to the patient their
with the plan may raise concerns
key phrases may help demonstrate that you have
or allow undisclosed agendas to
understood them. As the interview progresses,
acknowledge the history by facial expression and surface’
nodding, which helps patients move along with
their story.
I have never regretted asking a patient, ‘do you
Recording useful notes can be difficult during the
have any questions?’ However, this should not be
consultation. I prefer to make very brief notes, but
done in a hurried manner. Asking patients if they
try not to write whilst the patient is speaking. Try to
are happy with the plan may raise concerns or
acknowledge the patient’s problems. Agreeing that
allow undisclosed agendas to surface. Try to give
their problem is causing an impairment of physical
the patient a realistic expectation of the outcome
function is more likely to make them feel valued
of treatment. For example, recording a pain scale
as an individual. Surgeons have problems using
on an analogue zero to 10 scale may allow a more
empathic statements, often for fear of running out
objective measurement of progress at the next
of time in a busy clinical situation.
clinical visit.
It will be necessary to discuss a management plan
You can close the consultation by reviewing the
and to explain briefly the diagnosis and any tests
diagnosis, treatment and prognosis. Say goodbye
that may be required. Sometimes extra time may be
to the patient with an optimistic tone whilst shaking
required to do this. It is worthwhile taking time to
hands and making eye contact. Finally, remember
explain exactly how the tests will be organised and
every patient is different, and good luck!
the likely timescale.
Once the history and examination are completed, Chris Oliver is a Member of Council and a Consultant
ask the patient what they understand of the Trauma Orthopaedic Surgeon at the Edinburgh
condition. It will be necessary to explain the Orthopaedic Trauma Unit
surgeonsnews
cwoliver@rcsed.ac.uk
condition in terms appropriate to their educational
july 2004
vol 3 - issue 3