Building the Relationship: Person-Centred Communication
“A patient says "I've tried everything." What is the most useful thing you can say in the next ten seconds, and what is the least useful?”
The teaching
- Open, then listen. Elicit the person's agenda before steering. The first minute sets whether you hear the real reason for attending (Pendleton task 1; Calgary-Cambridge "initiating the session").
- Explore ideas, concerns, expectations (ICE). Ask about what they think is going on, what worries them, and what they hope will happen. Ideas shape adherence more than advice does.
- Explanatory models and culture. People explain their health through family, religion, cuisine, history and community. A plan that ignores these will be quietly abandoned. This links to Module 1's content on exposome and to South Asian cardiometabolic risk content (Dr Haq's own context). [Dr Haq to add one or two real examples from practice.]
- Core conditions in practice. Reflect feelings accurately (empathy), accept the person without agreeing with every behaviour (acceptance), and say honestly what you do and do not know (congruence). Congruence is what keeps a longevity practitioner from over-promising.
- Explain in plain language, check understanding, summarise. Neighbour's "summarising" and "handing over" checkpoints: say it back, give the person the next move.
- Communicating risk. Use natural frequencies ("about 10 in 1,000") rather than percentages or relative risk where possible; always give absolute as well as relative figures. This is the central lesson from the risk-communication literature (Gigerenzer & Edwards, BMJ 2003).
Applying it to longevity work
Biomarker results, biological-age scores and "optimal" ranges are exactly where risk communication matters most: they can reassure falsely or alarm needlessly. Teach learners to say what a number is, what it is not, and what would change the plan.
Translation box
Practitioner | Coach |
|---|---|
Discuss results with clinical context; own the interpretation | Explain only results a clinician has interpreted; avoid diagnostic language |
Use risk figures in decision-making | Use risk framing to support understanding; refer questions about treatment |
Myth vs Reality
Empathy takes too long.
Dr Haq’s practice example is awaiting author contribution; no numerical outcome claim is made.
Dr Haq’s 30 Seconds
A short personal take from your course director
Recording to come — 20–40 seconds in Dr Haq’s own words.
A note on the evidence
Risk-communication work shows that the format of numbers changes understanding (natural frequencies vs conditional probabilities). It does not show that any single phrasing improves clinical outcomes in longevity settings. State that limit.
Teaching caution: beliefs can influence engagement, but adherence has many causes; this is not a claim that ideas consistently outweigh advice.
Patient Journey — Checkpoint 14
Richard's hs-CRP was 2.1 mg/L. He asks: "Is that bad?" Write a three-sentence reply that says what the number is, what it is not, and what happens next, with no jargon. (Link back to Checkpoint 2.)
How would you apply the lesson to this conversation?
Mini case
A client's biological-age score comes back "7 years older than chronological age" on a consumer test. Draft what you would say. What would you refuse to say?
Reflect before you move on
When did you last give someone a number without telling them what it meant?
Video · live demonstration script · "say it in plain words" exercise.
References
- Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford University Press, 1984. (Seven tasks incl. ICE in task 1; via GPnotebook.)
- Neighbour R. The Inner Consultation. MTP Press, 1987. (Five checkpoints; via GPnotebook.)
- Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ 1996;30:83–89. (Task list and two-thread structure.)
- Rogers CR. On Becoming a Person. 1961. Core conditions summarised in StatPearls, NBK589708.
- Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005;55:305–312. (via NCBI DARE NBK71656.)
- Cahill K, Lancaster T, Green N. Stage-based interventions for smoking cessation. Cochrane Database Syst Rev. 2010;(11):CD004492. https://www.cochrane.org/evidence/CD004492_are-stage-based-interventions-more-effective-non-stage-based-ones-helping-smokers-quit
- Gigerenzer G, Edwards A. Simple tools for understanding risks: from innumeracy to insight. BMJ 2003;327:741–744.
- West M. Compassionate leadership: attending, understanding, empathising, helping (via FMLM materials).
- Elwyn G et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891. https://www.bmj.com/content/359/bmj.j4891
- Rubak et al. Full review: https://bjgp.org/content/55/513/305
- Gigerenzer & Edwards: https://www.bmj.com/content/327/7417/741
Consultation resources
- ICE & Consultation Prompt Card · PDF
- Explaining a Number · PDF
- Behaviour-Change Conversation Guide · PDF
- Referral & Scope Pathway Template · PDF
- Module 5 Self-Audit Worksheet · PDF
Key Points
- Pick one structure and use it deliberately for a week.
- Ask ICE in every first appointment.
- Give every number a meaning and a next step; use natural frequencies.
- Reflect before you advise.
- Name your scope and your referral route in one sentence.