Table 3.

Evidence Based Strategies For Addressing Challenging Communication in Orthopedics

General skill set1,7	Specific strategies (relevant example phrases in italics)	Relevance to common challenges
Skill Set 1 Create Rapport	Warm greeting “Nice to meet you” Small talk before big talk “Where did you drive from today?”	Demonstrates attention and interest in patient
	Sitting, eye contact	Conveys full attention/time for patient
	Address communication barriers	Early empathy for patient discomfort or language barriers
Set Agenda	Elicit list of all concerns related to orthopedic complaint “First I would like a list of what you are hoping to discuss during this visit”	Early identification of issues important to patient
	Negotiate agenda “We can address your pain issues, can I refer your other issue to regular doctor?”	Opportunity to clarify what can and cannot be covered in visit
Skill Set 2 Patient-centered History Building	Open ended questions “Tell me about your knee pain”	Allow patient to describe condition in their own words
	Active, reflective listening “So just to summarize…..”	Conveys to patient they are being heard
	Explore patient perspective (Idea, concerns, expectations, effect on life) “What do you think is causing this or might help this?” “What are you especially worried about related to your pain?” “What are you hoping surgery would do for your pain?” “How has this pain impacted your daily functioning?”	Explores what patient is hoping to achieve through intervention such as pain relief, better functioning, etc. Provides framework for treatment discussions.
	Consistent empathic responses to patient emotions “Sounds very frustrating”, “I’m sorry you have been in such pain.”	Conveys compassion for patient concerns and expectations
Skill Set 3 Educate, Counsel and Plan	Assess patient starting point “What have you heard/read about carpal tunnel syndrome?”	Clarifies patient understanding of condition and expectations for treatment
	Frame explanation using patient perspective/goals. “I know your hope is surgery could help your pain, unfortunately surgery won’t improve the cause of this pain”.	Aligns discussion with patient ideas, concerns, expectations
	Provide explanation in understandable chunks with room for ques-tions/perceptions “Physical therapy is useful for this condition, what questions do you have about it?”	Gives patient room to process and express ongoing concerns/questions
	Respond with empathy (acknowledgement, support, etc.) throughout “I know you are disappointed”, “I wish surgery could help your pain”, “We’ll work together to help you manage this.”	Acknowledges patient suffering, disappointment and goals, conveys partnership
Assessing Understanding	Ask patient to restate understanding of decisions, possible out-comes, management “Can you tell me in your own words what to expect as a result of this surgery?”	Increases retention of key components of discussion, allows for correction of misconceptions