The Expert Clinician

I’m Adam Widdison, author of The Expert Clinician. My work focuses on how healthcare practitioners (HCPs) think and how we can sharpen our thinking and performance in the demanding reality of modern practice.

In my previous blog posts —

Connection: The Secret to a Successful Consultation

Empathy: “I Want to Know What You Feel”

Impressions and Perceptions: What Patients Think Often Matters More Than Reality

Confidence, Trust and Respect: The Three Pillars of Every Successful Consultation

— I explored the skills needed to establish and strengthen the working relationship between HCPs and patients.

However, even when we do everything right, consultations do not always go to plan.

Patients might experience a range of emotions such as anxiety, fear, embarrassment, mistrust, disappointment, or anger. Sometimes, issues or conflicts arise, communication may falter, trust can diminish, and a barrier might develop, threatening the relationship. 

When issues, conflicts, barriers and concerns are not recognised and addressed, they can undermine confidence, trust, and respect, impair communication, and ultimately compromise care.

The good news?

Most barriers can be managed successfully.

When I sense a consultation is drifting off course, I use a simple, structured approach. In this post, I’ll share that framework.

Feel free to adapt the suggested phrases to suit your own style and clinical context.

A Stepwise Approach to Getting a Consultation Back on Track

When an issue, conflict, a barrier or concern arises, I follow five simple steps:

1. Identify – Spot the signs.
2. Decide – Is it worth addressing?
3. Learn – Understand the root cause.
4. Resolve – Manage the issue effectively.
5. Rebuild – Strengthen and maintain the relationship.

Step 1: Identify – Spot the Signs

Ask yourself:

Is there an issue to resolve?

It is not uncommon for patients to appear anxious, withdrawn, defensive, or hesitant when they first meet us.

Children, teenagers, and young adults may initially seem cautious or reluctant to engage. 

This is normal.

However, there are times when something more significant is occurring.

Patients may appear:

• Very anxious.
• Angry.
• Frightened.
• Embarrassed.
• Unhappy.
• Resentful.

Occasionally, patients may:

• Withhold information.
• Distrust us.
• Lose confidence in us or the healthcare system.
• Feel particularly vulnerable or insecure.
• Disagree strongly with our recommendations.
• Have unrealistic hopes or expectations.

For some patients, a clear issue exists, such as a complication, a mistake, an organisational failure, or a particular concern, such as delayed care or financial implications, that requires attention.

Concerns, conflicts, or barriers often reveal themselves through subtle clues.

It may be something a patient says, but more often it is apparent through tone of voice, facial expression, body language, or hesitation.

Recognising these signals early is often the first step towards a successful outcome.

Step 2: Decide – Is It Worth Addressing?

When an error occurs—an unintended or unexpected patient safety incident that could have resulted in death or harm—we have a Duty of Candour to inform the patient in person and offer a sincere apology, regardless of fault. 

Not every hesitation requires exploration.

However, addressing an issue is usually indicated when it is likely to affect:

• The patient’s emotional well-being.
• The quality of the working relationship.
• Confidence and trust.
• The exchange of information.
• Decision-making.
• The agreed management plan.
• Future adherence to treatment.
• Duty of candour

Information about the person can help determine whether to address the issue, when to do so, and how best to approach it.

Timing matters.

In most situations, concerns are best addressed when they first become apparent, while the patient is receptive and before they become entrenched.

Occasionally, haste may worsen a situation. 

Sometimes, a concern requires dedicated time in a future consultation, a second opinion, or support from another HCP, such as a counsellor, psychologist, or psychiatrist.

If so, explain this openly.

Step 3: Learn – Understand the Root Cause

Before attempting to solve a problem, seek to understand it.

Recognise and Acknowledge

Simple questions can open the door:

• Is there something you would like to talk about?
• I sense something is worrying you. Would you like to tell me about it?
• You seem concerned. Is that right?
• Would you like to talk about what’s on your mind?

Listen: Learn the Facts

This is often the most important step.

Avoid assumptions. Avoid being defensive. Instead, focus on listening.

You might say:

“Let’s start with me listening to your story. Then I’ll explain what I think and why, and together we’ll decide what happens next.”

Use open questions:

• Can you tell me more about that?
• Why do you feel that way?
• What worries you most?

Where appropriate, gentle leading questions can help:

• Is this related to what happened previously?
• Are you worried about the impact on your family or work?

Most importantly, give patients time.

Silence is not a problem to be filled. It often gives patients time to gather their thoughts and share what truly matters.

Listen in a supportive, caring way.

Show empathy.

Acknowledge emotions.

Validate experiences.

Simple phrases can be powerful:

• That sounds very difficult.
• I can understand why you feel that way.
• Thank you for telling me.
• Thank you for trusting me with that.

Often, patients do not need an immediate solution.

They need to feel heard.

Step 4: Resolve – Manage the Issue Effectively

Before responding, ask yourself:

What do I want to achieve?

Common goals include:

• Restoring confidence, trust, and respect.
• Preventing the breakdown of the relationship.
• Improving communication.
• Enabling information exchange.
• Aligning expectations.
• Supporting shared decision-making.
• Improving adherence to treatment.

Seek Permission

Patients may not always wish to discuss a concern immediately. Seeking permission demonstrates respect and preserves autonomy.

Open questions are often sufficient:

• Would it help to talk about that?
• Would you like to explore that further?

Respond Thoughtfully

Once the issue is understood, management becomes easier. Collaborating on a solution shares decision-making and fosters connection.

You might ask:

• What would help you most right now?
• What do you think would be the best way forward?
• What is most important to you?

Depending on the situation, it may be appropriate to:

• Provide reassurance.
• Correct misunderstandings.
• Offer information in different formats.
• Explore options together.
• Allow time for reflection.
• Arrange additional support.
• Recommend a second opinion.

When mistakes have occurred, a sincere apology is appropriate. For example:

“I’m sorry that happened. Let’s work together to make sure we get things back on track.”

Sometimes it’s important to set aside previous problems and focus on mutual interests, such as safety, quality of life, and trust.

“I can’t change what happened before, but I am committed to doing things differently from this point forward.”

Occasionally, a more directive approach is required.

For example:

• Telling the patient what they need: “You need a pacemaker”.
• Telling the patient what is available. “[Medication] is the only treatment available.”
• Telling the patient what to expect. “You will need to take medicine to clean your bowels”.

The key is ensuring that patients understand the reasoning behind the recommendation.

Step 5: Rebuild – Strengthen and Maintain the Relationship

Addressing a specific concern or issue is often straightforward. However, restoring confidence, trust, and respect typically takes longer

Relationships are rebuilt through consistent actions rather than words alone.

• Be patient.
• Be consistent.
• Keep your promises.
• Follow through on commitments.
• Show patients that your actions match your intentions.

Over time, this rebuilds confidence, strengthens trust, and restores respect.

Final Thoughts

Managing issues, conflict, barriers and concerns is a core consultation skill.

The best HCPs do more than diagnose disease and recommend treatment. They recognise when a consultation is drifting off course and have the skills to steer it back on track.

• Recognise problems early.
• Address them openly.
• Manage them thoughtfully.

When done well, they are opportunities to better understand the patient, strengthen the relationship, and improve care.

In my next series of blog posts, I’ll explore another essential consultation skill: learning about the patient as a person, not just as a problem.

How do you manage barriers or concerns in your consultations?

I’d love to hear your thoughts and experiences.

For a list of previous blogs, follow the link 👉 My Posts

These ideas are explored further in The Expert Clinician: Bridging the Clinical Divide. If you’re interested in developing a more adaptive, patient-centred approach, you can read more here: