Communication is the imparting of knowledge and understanding. Good communication is crucial for the surgeon in his or her daily interaction with patients. The nature of any interaction between surgeon and patient will depend very much on the context of the ‘interview’, whether you know the patient already, and on the quantity and type of information that needs to be imparted. As a general rule, the basis of good communication requires the following:

• Introduction.

Give your name, explain who you are, greet the patient/relative appropriately (e.g. handshake), check you are talking to the correct person.

• Establish the purpose of the interview.

Explain the purpose of the interview from the patient’s perspective and yours and the desired outcome of the interview.

• Establish the patient’s baseline knowledge and understanding. Use open questions, let the patient talk, and confirm what they know.

• Listen actively.

Make it clear to the patient that they have your undivided attention—that you are focusing on them. This involves appropriate body language (keep eye contact—don’t look out of the window!).

• Pick up on and respond to cues.

The patient/relative may offer verbal or non-verbal indications about their thoughts or feelings.

• Elicit the patient’s main concern(s).

What you think should be the patient’s main concerns may not be. Try to find out exactly what the patient is worried about.

• Chunks and checks.

Give information in small quantities and check that this has been understood. A good way of doing this is to ask the patient to explain what they think you have said.

• Show empathy.

Let the patient know you understand their feelings.

• Be non-judgemental

Don’t express your personal views or beliefs.

• Alternate control of the interview between the patient and yourself.

Allow the patient to take the lead where appropriate.

• Signpost changes in direction.

State clearly when you move onto a new subject.

• Avoid the use of jargon.

Use language the patient will understand, rather than medical terminology.

• Body language.

Use body language that shows the patient that you are interested in their problem and that you understand what they are going through. Respect cultural differences; in some cultures, eye contact is regarded as a sign of aggression.

• Summarize and indicate the next steps.

Summarize what you understand to be the patient’s problem and what the next steps are going to be.

The Royal College of Surgeons’ guidelines state that each clinical history sheet should include the patient’s name, date of birth, and record number. Each entry should be timed, dated, and signed, and your name and position (e.g. SHO for ‘senior house officer’ or SPR for ‘specialist registrar’) should be clearly written in capital letters below each entry. You should also document which other medical staff were present with you on ward rounds or when seeing a patient (e.g. ‘ward round—SPR (Mr X)/SHO/HO’).