The art of efficency
There is not really a specific formula for talking to patients that can be memorized so it really depends on the situation.
A patient I am seeing for the first time I like to start with:
"hello (socially/age acceptable title) my name is (what I expect to be called) what is your name?" (this is where they tell you what they want to be called)
It also yields a good amount of information. Do they readily respond? Do they know who they are and what I am doing there? If they can form a cohesive sentence I know broca's and wernike's areas are intact.
Are they more concerned with their complaint than with looking at me?
Do they respond in one breath or does it take several?
Since I am left handed, I often have to cross over the patient to work. Do they follow me with their gaze? Turn their head?
Did they make an effort to shake my hand or wave? (physically acknowledge my presence) If they did, was the movement fluid? Did they have trouble? Start with one hand and have to switch? Did they have trouble getting their hand to find mine? Did they succeed or give up?
"(What they wish to be called)what brings you here today?" (why did you call if responding to them) Psychologically they will give the most pressing complaint first. and we are off... I listen to every detail, analyze not only what they tell me, but the words they choose as well. I look at their general appearance, are they freshly bathed? hair combed? Teeth brushed? Are the trying to hide part of their body? Are they distracted? What are they wearing? Is it in good repair? Seasonally appropriate? Visible injuries or global signs? Other body language I find interesting or lack of body language I find significant? Skin color? Eye color?(the sclera, specifically) Nutritional status? Body symetry? If others are present how do they respond to them? Mood?
Probably some things i forgot to type that I notice.
If it is a patient I saw before, i usually forget their names. So I refer to social/age appropriate address. If the name is on the chart, I use that with Mr. Ms. etc. But then I start with:
"How are you feeling today?" before asking why they came.
With time and experience you will create your own style. In the meanwhile, you may want to have something to refer to so you don't forget anything.
As for small talk, it is an art. If the patient is quiet, I try to get them to interact by asking "what is going on? Do you have any questions? Is there anything I can do to help you?" "How long have you been here?"
There are obligatory questions: "Do you feel safe at home?" "Is anyone hurting you?" etc.
In addition to explaining what is being done, I also like to tell them how long it usually takes. It reduces their anxiety. I also usually tell them that as far as healthcare providers go, no news is good news. Don't worry if your labs take an hour. Worry if there are 5 providers in here with all kinds of gear. Especially worry if we are calling people to come and see you. (that is probably the worst sign)
If you are doing IFT, you can ask what they are being transported for and to where. Ask them how their treatments are going. Pass off thier concerns with your report. ask them if they are comfortable. Temperature, incline on the cot, maybe o2 settings too high? Position causing pain or discomfort?
Remember, medicine is first about helping people. If you can't cure their illness, focus on what you can do. Even if it is getting an extra blanket or glass of water or ice chips. Ask them what you can do to help. Sometimes you have to tell them it is not in your power or not possible. (like you have no pillows) But do your best to improvise.
A very wise preceptor of mine once said: "Be nice to your patients, even if you don't like them. You wouldn't think about suing your friend, but you will gladly sue your enemy."
Forget about sue, subsitute with "compliment" "cooperate" "offer" "complain" "withhold" etc.
