title: Twelve tips for asking and responding to difficult questions during a challenging clinical encounter.
abstract: BACKGROUND
  Teaching healthcare providers (HCPs) effective communication skills can be challenging, but is crucial for managing complex patient encounters.
  
  
  OBJECTIVE
  To provide medical trainees strategies for recognizing and understanding problematic interactions.
  
  
  METHODS
  The Twelve Tips are based on a study of communication skills teaching with family medicine trainees (n = 26) who received controlled exposure to common clinical difficulties simulated by standardized patients (SPs). The following tips were derived from a thematic analysis of a subset of the transcribed coaching sessions.
  
  
  RESULTS
  These tips demonstrate that doctor-patient communication difficulties can arise from any of three sources: the patient's issues, the HCP's misunderstanding or inaccurate responsiveness to an issue, and/or the interaction between the HCP and the patient. These tips are heuristically grouped into two themes: (1) guiding principles to hold in mind and (2) behaviors that can be used to apply these principles.
  
  
  CONCLUSIONS
  We believe that these strategies will help trainees to remain attentive to the patient, the interaction, and their own reactions, to improve the overall clinical encounter.
authors.affiliation: Centre for Addiction and Mental Health, Education , Canada and.
authors.forename: Sophie
authors.initials: S
authors.lastname: Soklaridis
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Hunter
authors.forename: Paula
authors.initials: P
authors.lastname: Ravitz
mesh_terms: D001291:Attitude of Health Personnel; D001519:Behavior; D003142:Communication; D005194:Family Practice / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D016544:Patient Simulation; D010817:Physician-Patient Relations