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

Small talk—big issues


Small talk can be a nice prelude to a more serious conversation. When open-ended and genuine, it may also create an opportunity for patients to bring up previously undisclosed and meaningful concerns. 

There’s an adage I learned about establishing rapport with patientssmall talk before big talk. The idea is to get comfortable with some informal conversation before broaching more serious health issues. I’ve found this technique particularly useful with newer patients, but sometimes casual talk can be anything but small.

Recently, one of my longstanding patients was in for some lingering respiratory symptoms. For this visit, we spent the first few minutes evaluating her main concern. As I was transitioning to the physical exam, I asked an unrelated general question.


“So, how’s life going for you otherwise?” 


Tears welled up in her eyes. “Terrible,” she replied. “I just buried my sister yesterday.” 


I spent some extra time helping her process this devastating loss. 


Small talk is probably a misnomer. I’ve learned to think of it as “opportunity talk,” since it may be just the door a patient needs me to open in order to share an important event or concern. This is especially so when small talk questions or comments are open-ended and genuine. 








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