Psychosocial sound bites: exercises in the patient-doctor relationship

In the course of evaluating and caring for patients, there are occasions when physicians feel "stuck" in not knowing how to respond to certain comments that arise during the interview. The difficulties may result from misunderstandings between patient and physician or from comments that reflect unstated issues. In both cases, mutual dissatisfaction ensues when these underlying factors are not properly addressed. Furthermore, particularly if feeling uncertain of the reasons for these difficulties or if dissatisfied with the conduct of the interview, physicians may respond in an authoritative manner, which diminishes the patient's ability to actively participate in the interaction. Included in this article are eight challenging comments made by patients in the course of a clinical visit. In each case, possible underlying theme(s) and responses that address these themes are provided as examples of a participatory style of communication. There can be more than one appropriate response. What is important is for the physician to develop a communication style that supports an effective patient-physician interaction, to improve the therapeutic outcome.