Managing the difficult consultation.

Patients are more likely to develop psychological problems if their concerns are unresolved and their information needs unmet. However, many health professionals are uncertain how to elicit patients' concerns or tailor information appropriately. These difficulties may also lead to psychological problems for the health professional. Feeling inadequately trained in communication skills has been linked to burnout amongst senior doctors working in cancer. Clinicians find that some consultations are particularly hard to manage; for example, when patients are highly distressed, angry, withdrawn or in denial. Barriers to effective communication are patient-led as well as doctor- or nurse-led but relevant training can help overcome those barriers. The article described one training model that is effective in improving health professionals' skills. Specific strategies are suggested that can help in the more difficult consultations and so enable clinicians to talk to patients about their concerns and worries more freely.