What is the first thing one tends to say to patients? Doctors all have stock phrases such as, ‘What can I do for you?’ It may be salutary to think about how one intervenes and what effect this may have on the consultation. One can be ultra-specific, perhaps referring back to an earlier problem such as, ‘Are you still spotting in the first week of the packet?’ which makes assumptions and sets an agenda for the patient based on the doctor’s concerns. Welcoming phrases such as, ‘Hello, Christine. Come in and sit down’ may be preferable. At least one is not asking a question. If one really wants to keep the agenda wide open this author has found ‘Yes . . .’ to be useful, or even total silence with an expectant look and firm eye contact. The latter example is obviously not appropriate for someone you have never met before. The temptation to use social chit-chat to break the ice: ‘Have you had a busy day at work?’ should be resisted as it may block the patient’s opening gambit. However, listening in stony silence for minimal cues when the patient wants a blood pressure check, a repeat prescription and to dash off to prepare something to eat can be felt as threatening and is a waste of the doctor’s and the patient’s time.
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