1. s e c t i o n
h e a d
1
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.
m i n d
y o u r
m a n n e r
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
surgeonsnews
july 2004
vol 3 - issue 3

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