Twelve tips for asking and responding to difficult questions during a challenging clinical encounter

Abstract

Background: Teaching healthcare providers (HCPs) effective communication skills can be challenging, but is crucial for managing complex patient encounters.

Aim: To provide medical trainees strategies for recognizing and understanding problematic interactions.

Methods: The Twelve Tips are based on a study of communication skills teaching with family medicine trainees (n = 26) who received controlled exposure to common clinical difficulties simulated by standardized patients (SPs). The following tips were derived from a thematic analysis of a subset of the transcribed coaching sessions.

Results: These tips demonstrate that doctor–patient communication difficulties can arise from any of three sources: the patient’s issues, the HCP’s misunderstanding or inaccurate responsiveness to an issue, and/or the interaction between the HCP and the patient. These tips are heuristically grouped into two themes: (1) guiding principles to hold in mind and (2) behaviors that can be used to apply these principles.

Conclusion: We believe that these strategies will help trainees to remain attentive to the patient, the interaction, and their own reactions, to improve the overall clinical encounter.

Acknowledgements

We would like to acknowledge Drs William J. Lancee, Andrea Lawson, Robert Maunder, Molyn Leszcz, Nancy McNaughton and Clare Pain for their contributions to the original study. We would like to thank Mr. Nick Gamble for his editorial services. We would also like to thank the reviewers for their feedback which served to strengthen the article.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.