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

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.