Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Choosing The Right Words


Using connecting language to seek deeper understanding of patients’ concerns may add richness to clinical encounters and help them feel safe. 

During his annual checkup, Mr. S requested a referral for counseling due to some marital troubles at home. This brought us to a branch point in the interview, a place where our choice of whether and how to inquire further could diminish or enhance our opportunity for connection and healing. 


Choice 1: “I’d be happy to recommend a therapist for you.” 

In the busy clinic setting, you may find yourself drawn to this response. Courteous and efficient, it offers exactly what the patient is seeking. We find, however, that this response misses out on a valuable opportunity to deepen trust in the patient-physician relationship. By sending the patient off to the next clinician, the PCP may not engage with the patient emotionally. The patient may, in turn, come to view the PCP as a conduit to other healthcare professionals rather than as a central figure in the management of their healthcare and well-being. 


Choice 2: “What’s been going on in your marriage?” 

A well-meaning PCP may be drawn to this response in hopes of exploring and better understanding the problem at hand. While suitable for some patients who already have a strong rapport with their PCP, this response can be construed as invasive or prying, particularly when the issue at hand is sensitive. Patients may be put in the difficult position of either finding some way of avoiding or engaging in an uncomfortable conversation. 


Choice 3: “Of course I can recommend a therapist for you. Is there anything about your situation that you’d like to discuss with me today?” 

We find that this response captures the strengths of the prior two choices while avoiding their pitfalls. In this response, the PCP shows willingness to connect the patient to the resources that they need while inviting further conversation. This gives the patient agency not only in choosing whether to engage in conversation but also how much and to what extent. We chose to pursue this response with Mr. S, allowing him to guide the conversation and share whatever he felt was comfortable.  


Using sensitive, connecting language can invite deeper discussion with patients, while allowing them to disclose only what feels comfortable and meaningful to them. 







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.