And yet, most people have never been taught how conversation actually works, which is why I started Bedside Manners.

I’m Sarah and, as my year 9 science teacher said in my school report, I’m very good with language (though I suspect she meant I talked too much). I’m a social scientist specialising in the empirical methodology of Conversation Analysis. I am one of Australia’s leading experts in studying communication as it really happens, turn-by-turn, moment-by-moment. My career has been dedicated to understanding the details of real conversations and translating that into practical training that genuinely changes how people work.

And that’s what makes Bedside Manners different.

Bringing the science of real conversations into everyday practice

We specialise in practical, evidence-based communication training that is grounded in real interactions rather than theories, imagined conversations, or generic advice.

Here’s what that looks like:

Self‑paced mini‑courses

Short, focused modules designed for busy professionals who want to learn at their own pace while still gaining research-backed strategies they can use immediately.

Personalised one‑on‑one coaching

Tailored sessions that target your real communication challenges such as leading teams, giving feedback, being empathetic, managing conflict, or navigating high‑stakes conversations.

Interactive workshops

Highly practical training for organisations and professional colleges that want meaningful skills development that is based in research relating specifically to the needs and professional contexts of the learners.

Expert research

We specialise in providing conversation analysis expertise through research. We currently offer the only contract conversation analytic research services in Australia as well as the only online, asynchronous course on how to do conversation analysis.

All of this means that when you learn with Bedside Manners, you’re learning strategies that actually work because they come directly from studying real communication in real settings.

What makes Bedside Manners the best at what we do?

1. We’re evidence-based

Every strategy is grounded in real communication data, not intuition or outdated communication theory.

2. We don’t do one-size-fits-all

Communication is complex, so we don’t sell you one-size-fits all solutions. Your role, your context, and your real interactions shape how we work with you.

3. We focus on what people actually say, not what they think they say

Most training relies on role-play or hypothetical scenarios. We analyse real interactions to uncover what’s really happening.

4. We combine research expertise with internationally recognised experience in teaching

Years of professional and academic teaching experience means the training is accessible, engaging, and designed to stick.

Ready to elevate your communication?

Whether you're looking to strengthen your leadership skills, improve conversations with clients, colleagues, or patients, handle tricky interactions with confidence, or simply refine how you communicate every day, Bedside Manners can help.

We’re here to make communication your most powerful professional tool.

If you’re curious about working together, exploring coaching, or bringing workshops to your organisation, we’d love to hear from you.

Recommendation of the month

There are two recommendations for this month. The first is a systematic review all about behaviour change in general practice, which demonstrates that guidance for communication about behaviour change is rarely supported by evidence relating to interactional practice.

The second is a paper from a former Macquarie University medical student, Terence Wong, who, along with Samuel Gray, Rhiannon Parker, Desmond Bokor, Sumit Raniga, and John Cartmill, and me, provide a detailed single case analysis of a surgeon doing person centred care in his approach to discussing diagnosis and treatment recommendations.

Online modules + CPD

Last year we launched three self-paced modules: The Science of Conversation, Communication in Healthcare Consultations, and Reflection for Improving Communication. These modules have been developed using an evidence base from analyses of real conversations. They are currently accredited by ACRRM and AMA CPDHome. They are available as a bundle at a reduced price for those working in healthcare. We are planning more modules for later in 2026. Please get in touch if you have a specific request.

In person workshops

We are kicking off the new year with some bespoke workshops at the GOODEM Evidence Review in Emergency Medicine. These workshops include analyses of recordings of real conversations from an Emergency Department, offering a truly specialised learning experience. If you’re interested in Bedside Manners developing such a workshop, get in touch today! We’re taking bookings from July 2026. You can find a summary of our offerings here.

Coaching

We’ve had a great time coaching people who want personalised feedback on their communication skills. We’re considering different ways of expanding our offerings in this space, such as voice coaching to help people manage using their voices all day long. Get in touch to find out more.

Research

We continue to offer research services, particularly in the specialised methodology of Conversation Analysis. Please reach out if you are interested in discussing possibilities.

Online modules + CPD

This year we launched three self-paced modules: An Introduction to Conversation, Communication in Healthcare Consultations, and Reflection for Improving Communication. These modules have been developed using an evidence base from analyses of real conversations. They are currently accredited by ACRRM and AMA CPDHome and we will seek new accreditations in the new year. They are available as a bundle at a reduced price for those working in healthcare. We are also delivering a 10-week asynchronous course on doing conversation analysis. This will be offered again starting early February 2016.

In person workshops

We have facilitated several bespoke in person workshops, including for RANZCO and SWSLHD. These workshops are designed with input from the organisers to ensure that the content and delivery are suited to the organisation's needs. We’ve already got more lined up for 2026, including workshops using recordings of real interactions to help people become adept analysts their own conversations. You can find a summary of our offerings here.

Expert advice for policy

I am now a member of the Communicating for Safety Advisory Committee for the Australian Commission on Safety and Quality in Health Care. It was a nice full circle moment having worked as a policy officer at the Commission while doing my PhD over 15 years ago to now being recognised for the expertise in healthcare communication that I have developed since that time. 

Coaching

We’ve had a great time coaching people who want personalised feedback on their communication skills. We’re considering different ways of expanding our offerings in this space, such as voice coaching to help people manage using their voices all day long. Get in touch to find out more.

Research

We’ve had the pleasure of working on research with teams at the University of Sydney and Macquarie University, providing expertise in the methodology of conversation analysis to their projects. We’ve already had some of that work accepted for presentation at the International Conference on Conversation Analysis in 2026. I have also continued adjunct PhD supervision during that time and have been working on papers from earlier research, including one recently accepted in Health Literacy and Communication Open. This means I started and ended my year with a publication in that journal! If you’re interested in research expertise in conversation analysis or healthcare communication, get in touch.

Outreach

We’ve continued to make connections with the medical community through other media, including Instagram and LinkedIn, and as an exhibitor and presentation prize sponsor for the first IMG Conference. I also appeared as a guest on the award-winning podcast How Humans Talk.

Thank you!

It’s a big thing starting a small business and I really want to say thank you for your interest in Bedside Manners as we continue to grow. If you want more regular updates, you can sign up to our monthly newsletter here.

I contributed as a Subject Matter Expert for the review of the Australian Communicating for Safety standard and I recorded a podcast for SBS. This month also saw Dr Avisak Bhattacharjee qualify for conferral of a doctorate from the University of Adelaide. As an external supervisor, it was great to be involved in work designed to better understand the impact of communication about breast density. You can see our most recent paper from that research here: https://onlinelibrary.wiley.com/doi/10.1155/ijbc/9997077

Recommendation of the month

I plan to include a paper/book/podcast of interest each month and start this month with a special section in the journal Research on Language and Social Interaction. This newly published section covers all things ethics for conversation analysis. It also includes a a paper specifically on healthcare interactions: https://www.tandfonline.com/toc/hrls20/58/2 

Contributions at Australian Commission on Safety and Quality in Health Care

For those of you who aren't as much on social media (!), I summarised my contributions at the Subject Matter Expert group last week. You can find the summary, with links to relevant papers, here: https://www.bedsidemanners.com.au/blog-1-1/contributions-to-the-australian-communicating-for-safety-standard

WHO Pandemic Agreement

It was great to see that the new WHO Pandemic Agreement includes multiple references to communication. Some of the wording closely reflects that within the submission by the International Association for Communication in Healthcare to the pandemic agreement. I summarised that process from evidence-based position papers to policy here: https://www.linkedin.com/feed/update/urn:li:activity:7330552688855646208/ 

Podcast

The first few episodes of a new series called How Humans Talk is now out. It features linguists and other experts on communication, including at least one conversation analyst (me!). The episode on healthcare communication will be out sometime in the next month, so keep an eye out: https://www.sbs.com.au/audio/podcast/how-humans-talk

Don't forget that our training goes beyond just that for healthcare providers, so recommend it to your friends.

Have a great June!

Sarah
Sarah J White, PhD, SFHEA, Director, Bedside Manners Pty Ltd

p.s. I've also uploaded a few silly communication designs to redbubble if you're keen for a nerdy t-shirt: https://www.redbubble.com/people/swhite-688/shop

This norm is present in everyday conversations as well as institutional ones. Personally, I say this a lot, particularly if I am explaining a concept or a project to someone and I’m not sure if I’ve talked to them about a particular concept before.

Establishing how much someone already knows about a story you have or about your health can be complicated, particularly if that other person has notes on you and you have no idea if they’ve read them or not.

Take the case of a woman who was admitted to hospital with a postoperative infection. She had also developed deep vein thrombosis after the surgery but before the infection. This was being treated with anticoagulants and both problems were treated in the same hospital, with a period of time at home between the two issues.

She recounts how a doctor came into her room, introducing himself and saying: “I’ve had a look at your notes …”

This doctor was coming in to cannulate for intravenous antibiotics. As she had already told the admitting team that she was on anticoagulants, she assumed the information about this was in her notes. Given that the doctor had said that he read the notes and didn’t ask about medications, she didn’t raise it.

Then, when attempting to cannulate, she bled much more than anticipated, to the doctor’s surprise. In response to his surprise, she asked if he knew she was on anticoagulants, and he did not.

There are multiple factors that could have led to this issue, such as whether the information had been placed in the notes or if the system made such information accessible. In terms of communication, though, the patient made the assumption that the information was known, so in the absence of additional prompting, did not re-tell it.

Often when we think of consultations and knowledge, we focus on the knowledge and expertise that the doctor brings. The patient also brings the knowledge of their condition and, at the start of a consultation and particularly at the start of a therapeutic relationship, will be in a much greater “knowledge-plus” (K+) position about their presenting problem and how it affects them than the doctor. This requires the doctor, who is in a “knowledge-minus” (K-) position, to ask questions. These are usually in the form of an opening question to elicit a patient narrative or problem presentation and then in history-taking questions.

The design of a doctor’s question reveals their epistemic stance, that is, how much information they either assume or know about the patient and their presenting problem. This can be in the opening question design. For example, “how can I help?” tells the patient that the doctor is not making an assumption or has no prior knowledge as to why the patient is there. Whereas, “you’re here to check your blood results?” clearly demonstrates some prior knowledge as to the reason for the visit. This can also happen in history taking, where the doctor will use assumptions based on aspects such as the patient’s age as well as information from previous visits, clinical notes, and referrals to design their questions in a way that demonstrates differing levels of prior knowledge.

The norm of not telling someone something they already know can have consequences in health care, where a question’s epistemic stance may seem at odds with how much information the clinician likely has.

Consider the impact of the referral letter on a doctor–patient consultation. Ordinarily, in a general practice consultation, the doctor does not know why the patient is attending. It may be they suspect that it is a follow-up from a recent injury or a routine appointment for chronic illness management, but the patient is able to raise different concerns and can do so without worrying whether the doctor already knows why they are there. The doctor asking an opening question like “how can I help?” makes sense as the patient knows that the doctor does not know why they are there.

In a referred consultation, however, the doctor is given a letter ostensibly for that purpose. The patient may or may not have access to that letter and any other information provided to the specialist doctor. Even if they do, they don’t know if the doctor has read it. As such, the patient is at risk of breaching the norm that you do not tell someone something they already know.

Specialists address this problem by frequently designing their opening questions differently as compared with general practitioners. They often acknowledge the additional information they have regarding the patient and request the patient to present their problem, for example, “I’ve got a letter here from Dr Smith but I want to hear from you what’s going on”.

This is called a referral recognition sequence and it mitigates the risk of the patient assuming that the specialist has more information than they really do, which would affect their problem presentation. When a referral recognition sequence does not happen, the patient might respond to an opening question such as “what’s brought you in today?” with a “I want to get my hip fixed”. This does not provide sufficient information about the problem and requires the doctor to further pursue a problem presentation.

This can create issues, particularly in settings where a patient may be unsure whether they should be providing a problem presentation at all and important clinical information may be missed.

This was the case for the woman I mentioned earlier, who assumed the doctor not only had access to the notes but had also read them. This was further reiterated by the doctor opening their interaction with “I’ve had a look at your notes …”, meaning that she would be more likely to breach the conversational norm of telling someone something they already knew, given he told her he knew things about her from his notes.

Addressing the patient’s assumption that you know something by being clear that you have some knowledge, but would like to hear it in the patient’s own words, can help patients know how much information to share with you.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2022/14/opening-questions-telling-patients-what-you-know/ 19 April 2022

By crossing out the “yes”, the nurse demonstrated her understanding of the phrase “fit and healthy” – that it referred to other diseases and illnesses. My friend, on the other hand, who exercises regularly, eats well, looks after her mental and physical health proactively, and has multiple sclerosis understood the question in reference to how she perceives herself.

While we could spend time discussing the conceptualisations of “health”, we can also look at what this means for communication in practice. When we teach doctors, we often say to avoid jargon, which is important given the low availability of understandable health information in Australia.

However, miscommunication is not just about medical terminology; commonly used medical terms as well as lay terms, like “fit and healthy”, can also be understood differently by patients compared with clinicians.

Take the attempt to simplify cardiovascular risk into the term “heart age”. On the surface, this seems like a clear solution; however, it reduces credibility of the information provided and does not improve engagement in behavioural change. The word “cancer” is another example, when used to refer to low risk conditions it can result in an increased desire for unnecessary invasive treatments.

The ambiguity of lay terms in clinical settings can also cause problems between clinicians, with varying understandings of the same words. While words, such as “fit and healthy”, can provide insight into a patient’s life outside the disease for which they are receiving treatment, the differences in understanding of what these words refer to and, in the medical setting, their general ambiguity, mean that information is not explored further.

Research methods that focus on how communication works in real life give insight into health literacy in practice. In conversation, we can identify whether someone has understood us by how they respond to what we have said. And when someone has shown they did not understand in the way we intended, we can adjust what we have said. This, in conversation analysis, is called “repair” and is necessary for mutual understanding.

This is an important concept when we look at health literacy in practice. We are constantly making decisions about how much the people we speak to know when we’re talking to them, such as when we ask them questions. Clinicians make choices about what level of health literacy the patient might have, which helps design an explanation. Listening to the patient response can give information about whether they pitched it accurately.

When providing one-to-one feedback to a doctor a few years ago, we noticed that the doctor often used medical jargon, even commenting to one patient that what they were explaining was “kind of technical”. In the recordings following training, which included advice on using less technical language and providing explanations when medical terminology was used, we observed that patients responded with more indications that they were following along with what the doctor was explaining.

More explicit approaches to assessing patient understanding come with their own challenges. Teach-back, usually a question formulated to elicit the patient’s explanation of what has been explained to them, is often advised as an approach to assess patient understanding; however, there is recent evidence that in practice explicit teach-back requests are met with more minimal responses in comparison with other approaches. By using a conversation analytic approach, the authors identified more effective ways of determining patient understanding. This included implicit teach-back questions, where doctors asked for information from third parties, and “experience questions”, which were questions that enquired after the patient’s experience so far.

It is impossible, and ill-advised, to suggest there is one right way to formulate a question or an explanation. You will continue to make choices for the patient in front of you and attentively listening to their responses will help you assess whether you need to make adjustments for your next turn at talk.

When we look at written information, considering the audience as well as the purpose is essential to assist patient understanding. In the context of survey questions, considering how their formulation affects the response is important. If the information required by the question about being “fit and healthy” is necessary for clinical decision making, then the question needs to be redesigned so that it is clearly understood in the same way by those asking and those responding. If it is not, then maybe it does not need to be asked.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2021/45/fit-and-healthy-reconciling-its-meaning-to-patients/ 29 November 2021

The anaesthetist was later surprised, and concerned, when during the operation the cardiac monitor showed frequent ventricular ectopic beats.

On my way back to the ward after midnight, a nurse mentioned to me, in my post-anaesthetic haze, that I would need to see a cardiologist. The next day the anaesthetist called me to tell me his concern at what the electrocardiogram had shown, given I had no heart problems. To which I sheepishly replied that I do in fact have a heart problem if one considers benign ectopic beats a problem.

I’d know about this for 4 years at least. So why didn’t I mention it? It would be easy to dismiss it. Perhaps I was emotional and distracted given the reason for the surgery. Maybe it was because of the late hour of the surgery and I was too tired to remember. But when I look back on it, I can see an interactional reason.

To understand medical questioning, we must look at the multiple factors that influence how those questions are designed. As a clinician, you probably don’t even realise you’re making this multitude of small decisions all throughout the consultation. Not just what information you need, but the decisions you make in terms of how you will ask it.

Questions have preferences – both grammatical and social. I’ve previously mentioned the influence grammatical preference can have on patient response. You can see that the question I was asked, “do you have any heart problems,” is more likely to receive a “no” response because of the word “any”. Beyond this grammatical preference, Heritage and Clayman describe both congruent and cross-cutting social preferences that influence question design in medicine.

Question design in medical consultations — that is, how you ask a question — is guided by three key principles: optimisation, problem attentiveness, and recipient design.

Optimisation refers to how questions can be designed to assume a favourable health or social response from a patient. In “do you have any heart problems,” no is the preferred answer because the favourable health response is that I do not ,and there was no reason to necessarily believe that there was a “problem”.

Problem attentiveness refers to the moments when optimisation is not appropriate, usually in regard to the presenting concerns or knowledge of another existing health concern. If I’d been seeing a cardiologist for palpitations, on the other hand, and they’d asked “do you have any heart problems?” I might think it odd because that would be why I am there.

Recipient design refers to asking a question with the addressee or recipient’s circumstances in mind. This is a more general principle that guides conversation. Perhaps if I had been older or male, the recipient design principle would have prompted the anaesthetist to ask it in a different way based on the assumptions related to that demographic information.

These principles might seem unnecessarily technical, but they provide insight into why you design questions in particular ways, why a patient might answer with a “no” to you but with information about a problem to another clinician, and why sometimes it can seem tricky to ask a question when these principles are cross-cutting.

“Do you have any heart problems” is not inherently wrong, it just didn’t work for me. With the “any” as well as the use of the word “problem” when the ectopic beats had previously been considered not a problem, I was not prompted to disclose relevant information – it didn’t even cross my mind. What could have the anaesthetist asked me? If the question had been “have you seen your GP or a cardiologist about your heart?”, I would have been more likely to say “yes”.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2021/40/asking-the-right-question-for-the-patient-in-front-of-you/ 25 October 2021

This is our first newsletter! It's been an exciting and productive few months, with Bedside Manners becoming the full-time gig for me. As the Director, I've been creating a range of different training and development opportunities as well as sharing more about the science of conversation analysis on social media https://www.instagram.com/the_conversation_doctor/. I'm looking forward to recording a podcast episode later this week that I'll share with you next time.

Healthcare Communication Online Training Bundle

We offer three online mini-courses specifically for healthcare communication. These are all individually CPD accredited by the Australian Medical Association and the Australian College of Rural and Remote Medicine. We are now offering all three as a bundle at a discounted rate: https://bedsidemanners.thinkific.com/bundles/communication-in-healthcare

Conversation Analysis - Methods Course

The 10 week methods course is being planned! We are so excited to be offering this opportunity to people who are new to or earlier in their knowledge and use of conversation analysis. Please contact us for more details.

Blog

We have a blog with some new posts as well as re-published posts from articles previously published in MJA InSight+. These posts are all about communication in healthcare but will extend into other aspects relating to conversation analysis soon: https://www.bedsidemanners.com.au/blog-1-1

Research services

We offer a range of research services, particularly with expertise in conversation analysis. We've recently started some contract research work with a group at the University of Sydney and are keen to engage in more opportunities.

If you have questions about what we offer, please get in touch.

Sarah
Sarah J White, PhD, SFHEA, Director, Bedside Manners Pty Ltd

There is a lot of stigma attached to medication management of chronic pain, so I often find it difficult to bring it up, even though my regular GP developed the management plan with me and is invariably the one who prescribes it. My concerns about raising it are based on how I feel I will be perceived and on the assumptions that I know could be made about my expectations for treatment.

Doctors use all sorts of heuristics to make decisions and some of these can lead to incorrect assumptions about what patients want and expect. Patients bring their own assumptions too, just like my assumption above that I will be perceived negatively or that there will be resistance, so I design the way I talk to avoid that as much as possible. These assumptions influence, and are influenced by, how doctors and patients communicate with each other.

As these assumptions are evident in consultations, they can be examined through close analysis of recordings. In consultations with surgeons, for example, we can see that patients and surgeons orient to surgery as being the default treatment recommendation. This is not to say that surgery is the preferred option in all or even most cases, but that recommendations for non-surgical management require more interactional work. Recommendations for surgery tend to be presented early and in a straightforward way while recommendations for treatment options other than surgery are delayed and include more justification about why surgery is not the recommended treatment. The assumption is that a patient seeing a surgeon is possibly expecting for surgery to be the recommended treatment option and that surgeons design their recommendations for something other than surgery to counter potential resistance against a non-surgical recommendation.

Similarly, there is an assumption that parents of children sick with upper respiratory symptoms expect antibiotics. While it might feel like that as a clinician, and there would be variation between cultures and medical systems, there is some evidence that tells a different story. Doctors’ perception of parent expectation for antibiotics can be influenced by how a parent presents the child’s illness. If the parent presents a candidate diagnosis, such as “I think my child has tonsilitis”, a doctor is five times more likely to assume that the parent is wanting a prescription. Yet, in this study, this did not match with parent-reported expectations, with other reasons for parents presenting candidate diagnosis, such as legitimacy in seeking care.

Doctors are generally adept at gaining acceptance of treatment recommendations from patients through persuasion, although being responsive to resistance is not the only strategy that can be used. Just as in the surgical consultations described above, there is extra interactional work that doctors do to reduce resistance to treatment recommendations.

By providing a positive action, such as resting and drinking fluids, before telling the patient that antibiotics aren’t suitable, there is higher likelihood of acceptance of the recommendation not to prescribe antibiotics. This can be pre-empted even earlier in the consultation than the treatment recommendation. In response to the problem presentation, doctors can foreshadow the likelihood that the illness is viral to manage patient expectations.

These kinds of strategies to manage interactional resistance may be taught explicitly. During a project where I was observing handovers at an emergency department to develop training material, I watched a senior doctor coach an intern on how to more successfully transfer a patient to a larger hospital.

Many of these strategies would also be developed by the clinician over time through trial and error, with repeated consultations acting as a wind tunnel to find what communication practices result in a smoother consultation.

Using the evidence from the antibiotic prescribing research mentioned above, a training module has been developed as another way to support doctors to more strategically use interactional means to reduce resistance to non-antibiotic treatment recommendations.

Adding in an extra level of expertise through detailed analyses of clinical practice and development of related training can further support doctors to improve consultations in a more systematic and evidence-based way, including how to better understand their own assumptions of patient expectations and how to manage patient resistance to treatment recommendations in a person-centred way.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2021/36/talking-about-treatment-expectations-with-patients/ 27 September 2021

As I was a new patient, the doctor wanted to take a slightly broader history, which made sense to start with as that gave her some more contextual information. But I was surprised when she decided to explore something in more detail: “Let’s talk about your weight”.

Part of that surprise was because at the start I had explained that this was a one-off visit to the clinic and that I’d follow up with my regular doctor if I had ongoing symptoms. It was also because it really seemed out of the blue for a consultation about a cold.

I didn’t think about this incident much until just last year when a friend of mine went to see a GP about a lump in her breast. She decided it would be worth seeing someone that had a good reputation specifically in this aspect of women’s health. It was her second ever visit to this doctor and the first for this concern.

After a very brief examination, the doctor declared: “I’m not concerned about your breast, but you are very overweight”. This was followed by my friend being put on an extremely restrictive diet so that she could lose weight quickly, without so much as a discussion as to her general medical history or lifestyle or mental health.

In news that is unlikely to surprise you, neither of us lost much weight after these encounters. It is also not an uncommon experience for overweight people, and particularly women, to have our weight be front and centre in consultations. The fatness can often be the first problem source considered for symptoms, which can result in missed diagnoses along with a reluctance to seek further care in environments where fat patients can be treated with less respect, resulting in lower trust.

Health behaviour change strategies such as motivational interviewing are being more frequently recommended as a good approach to all sorts of lifestyle concerns. These kinds of patient-centred strategies have reasonable outcomes within study environments, but how does talking about weight work in the wild? In practice, talking about weight is hard for a variety of reasons, including difficulties in even broaching the topic and the awkwardness of such conversation.

When considering raising weight, some research has shown that one of the more effective strategies is to ensure it is linked to the patient’s presenting problem. Rather than raising weight as an additional concern, highlighting the clinical relevance of weight opportunistically can allow for more positively received brief interventions.

This needs to be done carefully because there is some evidence that it may be met with resistance, particularly if the link was not clear to the patient. This may be due to the larger social issues at play – the ongoing issues of stigma and moral accountability for weight can make starting conversations difficult. If weight is raised in ways that are not sensitive to these issues, it may delegitimise the patient’s request for medical attention.

No matter the approach used, listening to the patient’s response is crucial. Recent research into referrals to weight management services in the UK showed that simple affirmative responses from patients, such as a “yes” or “yeah”, are often interpreted as positive uptake by the GP. But, in reality, these were not associated with engagement with the service. Instead, patients who gave more enthusiastic affirmative responses, such as “oh yes” or “lovely”, were more likely to take up the suggestion.

Equally, when a patient seems resistant, pursuit of positive uptake is not helpful. Resistance is not something that needs to be overcome. Instead, it can be a window into the personal and social barriers for the patient in taking on lifestyle advice and offers an opportunity for the doctor to modify that advice rather than simply repeating it.

These studies have found that providing positive advice and foregrounding general principles of being healthy regardless of weight were more likely to get uptake from a patient. The mixed evidence on how to do this highlights that more research is needed to identify the more effective approaches in different clinical and cultural contexts. For now, carefully listening to how patients respond while checking for your own possible bias toward fat patients and their concerns will make these conversations easier.

Special thanks to A/Prof Maria Stubbe and Dr Charlotte Albury who provided advice on this article. All errors remain my own.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2021/33/when-and-how-to-talk-about-weight-with-patients/ 6 September 2021

It’s just one word, so you might not think it would make a difference. But it really did. What was already known from interactional research was that “any” is more likely to get a no response, while “some” is more like to get a yes. When the analysis was conducted, the authors found that for patients with multiple concerns and who were asked “anything else”, 53.1% raised another concern. For those who were asked “something else”, it was 90.3%. One word can really make a difference.

In my experience as an educator, doctors really like this study because it is a seemingly simple change that can make a big difference. And, if I’m being cynical, there is a higher value placed on quantitative research. But focusing on one word might distract from the problem being addressed: patients’ unmet concerns.

I’m the kind of patient that comes in with a list when I see my GP. I save a few things up and then go, and I’m not alone. I’m also the kind of patient that whips out my list at the start of the consultation, pre-empting the upfront agenda setting that can help doctors manage a consultation. Upfront agenda setting is when the doctor and patient establish what concerns will be discussed near the start of the consultation. It helps plan the structure of the consultation and results in fewer surprise topics being raised later in the visit. And because it assists in time management, upfront agenda setting does not make the consultation longer.

My own research has focused on surgeon consultations where multiple concerns might be less expected for patients compared with primary care. That said, in ongoing work looking at general practice consultations, we have not come across upfront agenda setting much either, even when it turns out patients do have multiple concerns that they pursue without prompting.

This is reflected in research that found that agenda setting, upfront or later, occurs infrequently. If a doctor solicits additional concerns early in the visit, patients are more likely to respond with additional concerns than if it were later in the visit. Equally, if the patient raises their own additional concerns, earlier is also better as it’s more likely to get addressed by the doctor.

Upfront agenda setting works, so why doesn’t it happen more often?

My research involves recording and analysing real consultations and I’ve noticed that doctors have their own habits and styles. This is good as it means communication is authentic and reflective of their own characteristics. However, it might make new habit-forming more difficult. Communication is part of all medical programs in Australia; however, without a specific review on content or a national curriculum for communication, it is unclear whether the particular skill of upfront agenda setting is taught. Perhaps the doctors I have recorded were not taught upfront agenda setting at medical school and those that have may have incorporated it into their consultation style.

There’s good interactional research that supports introducing upfront agenda setting into the consultation. Beyond including it in medical training, this could be taught to practising doctors through recording consultations and reviewing them to help identify their own practices and how they might incorporate such a change in their own approach to consultations. Just like any new skill, communication skills can be taught and learnt, and practice is what facilitates improvement. If you do try it, just don’t forget that one word can really make a difference.

Originally published on MJA Insight+ https://insightplus.mja.com.au/2021/28/managing-multiple-patient-concerns-in-a-gp-consultation/ 2 August 2021