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TALKING WITH PATIENTS People visit doctors for many reasons. Sometimes it is for medical physical exambecause something unexpected and catastrophic has happened to them, but usually it is because of an ongoing problem, a relatively minor complaint or because something 'isn't right'. Before coming to the doctor they may have spoken to family or friends, tried remedies suggested by them, spoken to other health professionals, e.g. pharmacists, or complementary practitioners, or may have found information on the internet and brought this with them. Their decision to go to a doctor may only have been made after these attempts to explain or heal their illness or problem have been unsuccessful. By the time they have reached a doctor most patients have formed some idea of what might be wrong with them and will have worries or concerns that they need to talk about.

The general practitioner (GP) or family doctor is usually the first point of contact. Even a straightforward visit can be a big event for patients. They have to decide to go, usually make an appointment, work out what they are going to say and may have to arrange time off work or for child care. They then have to sit in a waiting room. This is an almost universal human experience; think about how it affected you the last time you had to do this. Things can become even more perplexing if the visit is to a hospital outpatient department or part of a hospital admission when their anxiety and apprehension can get worse as this is where 'serious' things happen. Whatever the cause, patients are seeking explanation and meaning for their symptoms. Whatever the setting, the doctor needs to try to work out why patients are there, what they are most concerned about and to agree with them the best course of action. The first and major part of that is talking with the patient. If you listen carefully they will probably tell you what is wrong with them, will certainly tell you what is concerning them, and the physical examination will help you to confirm this or not. Communication is integral to the clinical examination and is most important at the beginning to gather information, and at the end to share information and engage your patients in their management.

Patient participation

Good communication is essential in good patient care; it supports the building of trust between doctor and patient and helps you provide clear and simple information that improves health. This allows you and the patient to understand each other and agree goals together which suit each individual patient. Communication is much more than 'taking a history', it is an integral and important part of looking after patients and is the only way they can be involved effectively in their health care. Poor communication leads to misunderstanding, conflicting messages and patient dissatisfaction and is the root cause of many subsequent complaints and litigation.

Beginning That all sounds very well but how do you do it?Our personal experience of illness is unique and often difficult or embarrassing to explain. To make this easier for your patient consider the following.

Where will you see your patient? Ideally in a quiet, private space. This is usually easy in a GP surgery, but often difficult in hospital. In hospital outpatient departments nurses or students are often present, and in hospital wards privacy is often only afforded by curtains - which means no privacy at all. You must be sensitive to your patients' privacy and dignity in all circumstances. If you are seeing the patient in a room and have others with you, for example junior colleagues, introduce them and ask permission for them to be there. If your patient is in a hospital bed but can get up, a side room or interview room may be used. Often there is no alternative to speaking to patients at their bedside, so let them know that you understand that your conversation may be overheard and give them permission not to answer sensitive things if they feel too uncomfortable about it.

Consultation length varies. In general practice in the UK the average length is 10 minutes. This is usually adequate as the doctor may have seen the patient on several occasions and know the family and social background. In hospital 5-10 minutes may be adequate for return outpatients, but for new and complex problems much longer - 20-30 minutes - may be needed. If you are a student learning to talk with and allow 30 minutes at least. Plan your time around how long you expect your patients to take so that others are not kept waiting, and be prepared to be flexible.