The first visit can make or break a relationship. In this chapter, we are going to talk about two principles key to developing a working relationship: asking first, and negotiating an agenda. These skills will help you start off on the right foot and build rapport with your patient.

A common problem

Several years ago, one of us (Tony) saw Jan D., a 50-year-old woman who had just had a breast biopsy showing cancer. Afterwards, she said that Dr. Back wasn't “in tune” with her from the beginning of the visit. “He seemed nice enough, but after a few minutes of questions about my allergies and family history, I interrupted and said ‘Could we cut to the chase here?’” Tony was equally frustrated for a different reason. “It was one of those days when everything went wrong. But when she interrupted me, I realized I had blown it. She didn't think I was paying attention.” What went wrong? They didn't agree on the agenda for the visit. Let's take a look at the encounter in detail.

Although Tony is doing a terrific job collecting the medical data, he is failing to connect with Jan D.'s concerns. The big problem is that he and Jan D. never negotiated the agenda for the visit, and so the visit defaulted to a discussion of the medical details (the doctor's agenda).