Table 1.

Elements of Patient—Provider communication.

Elements of Communication	How to	Example
Build the relationship	Greet warmly	Use eye contact and smile when greeting the patient
	Elicit full agenda set priorities early in the interview	“Is there anything else bothering you?”
		“How can I help you the most today?”
Listen actively	Start with open ended questions	“Tell me more about the pain”
	Use silence—repress the desire to respond with advice or an opinion (do not interrupt particularly in the first few minutes)	Nonverbal elements of active listening (directly face the person with open body relaxed posture, maintain eye contact, lean forward, head nodding)
	Paraphrasing—rewarding a statement usually with less words	“You had severe pain for a very long time”
	Clarifying—transforming unclear information into clear	“Sounds like you have seen many doctors and tried quite a few treatments without much success”
Use Empathy The ability to understand the feelings of another person	Encourage emotional expression	“How does this situation make you feel?”
	Identify and accept/validate feelings	“I can see how difficult it has been for you to cope with these severe symptoms”
	Demonstrate empathy—verbally and non verbally	“It must be very frustrating to feel that no one understands.”
Elicit patient’s perspective	Patient’s beliefs regarding the illness	“What do you think is the cause of your illness?”
		“What do your family and friends think about your condition?”
	What is the impact on the quality of life	“How are these symptoms affecting your life?”
	Disease-related worries/anxiety	“What are you worried about in relation to your IBS?”
Provide education	Elicit prior knowledge and educational needs	“What would you like to know about IBS the most?”
	Correct misconceptions	“IBS does not become cancer or colitis”
	Facilitate learning through problem solving	“Let’s think what can you do if you are at work when the pain starts?”
	Test for comprehension	“Can you tell me what you understood about this medication so far?”
Negotiate a mutual treatment plan	Use patient’s frame of reference	“You described the burning sensation that …”
	Involve the patient in the decisions	“Which of the treatments we talked about are you most interested in trying?”
		“What do you think will help the most?”
	Explore plan acceptability/barriers	“Do you think you will be able to stick to this plan?”
		“How can we make it easier?”
	Set a realistic goals	“Lets agree on working on making the symptoms better even though we may not be possible to make them go away completely”
	Encourage questions	“What questions do you have about..?”