The Art of Conversation

By Adam Widdison, author of The Expert Clinician

A consultation is, at its heart, a conversation—but not an ordinary one.

It is a purposeful exchange in which the patient and the healthcare professional (HCP) are both trying to understand something, and each holds information the other needs.

Treating patients as people with a problem from the first moment is essential if we are to deliver compassionate care.

The opening of the consultation establishes the aims and initial focus. Once those aims are agreed, everything that follows depends on effective information exchange.

In this and the upcoming posts, I will examine what makes that exchange effective and why the skills involved go beyond simply asking questions and providing answers.

From First Hello to Shared Understanding

All consultations start with an introductory conversation and finish with a concluding conversation (URL).

A friendly welcome and a brief, informal conversation can make the patient more comfortable. But the beginning is not just about being polite; it is when goals are established, and the initial focus of the encounter is determined.

From there, the consultation should proceed flexibly, guided by what the patient says and what is discovered, while remaining aligned with those aims.

A new or complex patient may need time to build trust.
A new problem may require sufficient detail to reach a working diagnosis and plan.
A follow-up after tests or a trial of treatment may shift the focus towards discussing the results and agreeing a plan.

At the heart of every consultation is the conversation: an active process of gathering, making sense of and sharing information.

For the HCP, it means learning about the person, the patient and the problem.

For the patient, it means learning about their problem and understanding the HCP’s opinions and recommendations.

Effective information exchange is therefore both a goal and an enabler:

Without an accurate understanding, we cannot diagnose or plan effectively.
Without understanding, the patient cannot make an informed decision.

A well-conducted conversation, with relevant questions, compassionate listening and clear information sharing, accompanied by a thorough professional examination, reassures the patient that they are heard and understood. It also encourages their engagement in care and strengthens the working relationship.

Art and Science

Information exchange is both an art and a science.

The art lies in creating an environment where patients feel safe enough to speak openly and trusting enough to be examined.

The science is knowing which information is relevant, which questions to ask, which signs to look for, and how to interpret what is discovered in relation to the aims of the consultation.

This requires communication and examination skills, cognitive skills and medical knowledge, together with the ability to conduct a consultation efficiently and purposefully.

There is an important principle underpinning all of this:

The consultation should be deliberate, not routine.

The conversation should inform the examination, and the examination should raise further questions. The two processes work best when they feed each other rather than running as separate, routine stages.

An Illustrative Moment

Peter, a 54-year-old builder, sees an HCP about a lump on the back of his wrist. After a brief introductory conversation, the HCP examines it, identifies a ganglion, explains what it is, and discusses treatment options. They agree on a plan. The consultation lasts a couple of minutes. Peter leaves knowing what is wrong and what will be done.

Job done?

Yes—because the patient leaves satisfied: he knows what is wrong and what will be done.

However, a consultation that works well for one patient may not work for another.

Sarah, 62, enjoys playing tennis and sees a surgeon about pain in her right knee. While Sarah is sitting, the surgeon looks at the X-rays and, without looking up, says:

“You’ve got severe osteoarthritis; you need a knee replacement. The waiting list is normally at least nine months, but we have a cancellation next week. I could do it then if you’d like?”

Sarah is about to ask a question when the surgeon leans over and says:

“Here’s the consent form; please take a look and sign it here.”

Sarah leaves, and the surgeon makes the necessary arrangements.

Job done?

Definitely not.

Sarah leaves feeling overwhelmed, confused and unhappy. She is very nervous about surgery and wanted to discuss the options.

What went wrong?

The surgeon focused on the diagnosis and treatment without first understanding Sarah’s perspective. The conversation was largely one-way. He assumed that surgery was what she wanted, did not explore her concerns or expectations, and gave her little chance to consider alternatives or ask questions.

Sarah was asked to make an important decision without the opportunity to discuss her problem, understand the options, or consider the nature of the surgery, its risks, and its likely benefits in the context of her circumstances.

The difference between the two consultations is not simply that one was short and the other was rushed.

The first addressed what mattered to the patient; the second did not.

Understanding the problem is important.

Understanding the person is essential.

One of Many Conversations

Remember that the spoken conversation between the HCP and the patient is only one of many conversations taking place.

Unspoken conversations also happen in our minds: what both the patient and HCP think before something is said, and what they think about afterwards.

Some of these thoughts may be expressed through silences, tone, facial expressions or body language. Others may remain hidden.

These unspoken conversations matter because they influence how the patient and HCP experience the consultation.

Take-Home Message

Information exchange drives the consultation.

The conversation is more than simply exchanging information. It is a shared process through which the patient and HCP develop an understanding of the problem, the person and what needs to happen next.

Keep it intentional. Every part of the consultation should have a clear purpose.

Treat the patient as the owner of their problem. Seek to understand what matters to them, not simply what is medically wrong.

Done well, the consultation becomes not merely efficient but meaningful—for the patient, the clinician and the working relationship that carries care forward.

I’d be interested to hear your thoughts.

Have you ever had to uncover a “hidden problem”?

Have you experienced a consultation where the conversation changed the direction of your care?

In my next post, I’ll explore why the words we choose—and the way we deliver them—can shape how a patient understands, experiences and responds to a consultation:

The Art of Conversation: Words Matter.

Do we know which question to ask?

We explore these ideas 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: