Challenging Encounters

Patient encounters can be challenging for numerous reasons including but not limited to:

  • Patient Factors
    • Communication styles
    • Personality obstacles
    • Many/unexplained symptoms
    • Emotions
  • Elements of the interaction
  • Physician factors

So, with all these potential complications how do physicians communicate effectively and build trustworthy relationships with their patients? Keep reading to find out! 

*Disclaimer: This article is not meant to place blame nor is it meant to be comprehensive.

Dealing with Common Issues

  1. Patient Communication Styles
    1. Vague: Ask for specifics
    2. Rambling: Tactfully redirect but REMEMBER silence is NOT a good idea
    3. Silent: Rephrase open-ended questions and offer choices
  2. Patient Personality Obstacles
    1. Demanding: Avoid debates, urge patient to cooperate and acknowledge their right to good health care
    2. Self-destructive: Create open non-judgmental environment and DO NOT blame patient
    3. Seductive: Maintain professionalism and refuse inappropriate requests
  3. Patient has many/unexplained symptoms
    • Reflection: “You seem [insert feeling here] …”
    • Validation: “I can see how you would feel …”
    • Respect: “I can’t believe how much you are able to do even with your hindering symptoms.”
    • Partnership: “Let’s work together to improve your function and reduce your symptoms …”
    • Avoid excessive tests/referrals
  4. Patient Emotions
    1. Sadness
      • Let patient control how/when they want to discuss
      • Empathetic response
        1. Reflection
        2. Validation
        3. Respect
        4. Partnership
    2. Fear
      • Invite patient to discuss fears
      • Avoid false reassurance
      • Empathetic response
    3. Anxiety
      • Reduce uncertainty
      • Give clear instructions
      • Empathetic response
    4. Anger
      • Apologize if it’s YOUR fault, explain the reason for your actions
      • Empathetic response
  5. Elements of Interaction
    • Reduce communication barriers
    • Explore patient’s views and goals
  6. Physician Factors
    • Learn to recognize your emotions in real-time!
    • Reflect on emotions over time, especially negative ones
    • Learn to accept constructive feedback from patients
    • Mindful practice: self-reflection


Much thanks to Charles Christianson, MD, ScM for teaching a tremendous amount of clinical knowledge to my classmates and I!

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