A Rhetorical Approach

The language we use in communication makes possible, and constrains, the thoughts other people have about what we do.  Language is more than just a vehicle for ideas… language shapes the ideas that we can have.  Think about the impact that our choice of noun has when referring to the people we help care for.  Are they patients? clients? participants? consumers?  Not only are the differences not semantic, they telegraph our position to our audience instantly, and give them a heads up on whether or not we’re all on the same page.  For good OR for bad…

After we find our “Marcias”, it’s important for us to build trust, to advertise our worth, and to engage their attention.  One way to do this is to share their orientation to the world by paying attention to the language that we use in communicating.

Overall, you can find the complete path to integration here.

But before you get too far into it, start by thinking about how we might continue to create value through better communication skills.

The Patient Presentation

A great presentation requires style as much as substance; your delivery must be succinct and smooth.  No time should be wasted on superfluous information.  Ideally, your presentation should be formulated so that your audience can anticipate your assessment and plan.  Each piece of information should clue the listener into your thinking process and your most likely recommendations.

Before you speak, consider…

  1. Audience:  Who are you speaking with?  What do they need to hear?  What kinds of distractions are they likely to be dealing with? What are the limits of their attention?
  2. Message: What are the one or two points I need to make?  What’s the best way to make them?  How can I highlight the fact that my point has just been made?
  3. Purpose: Why is it important that my message meet my audience?  What do you want to accomplish with this communication?  How will things change after our discussion?

Types of Patient Presentations

New Patient

Communications regarding “new” patients should include elements of a traditional history.  Give the chief reason they came to you, and follow it with pertinent elements of their illness history.  Next give important past medical history or social history elements that are likely to influence the approach to care.  Feel free to give both pertinent positives and negatives.

The assessment and plan should include what you think the nature of the problem is, and why.  Then, state what you plan to do for the patient.  Highlight your questions, or your needs, here.


The follow-up report differs from the discussion of a new patient.  It is usually an abridged presentation, perhaps referencing major patient issues that have been previously presented, but focusing on new information about these issues and/or what has changed.  Report any new findings you have made, response to treatment that you have observed, and highlight your resulting recommendations +/- any outstanding questions or needs you have.

Ask yourself what you want the presentation to do

  1. Request a consultant’s advice on a clinical problem: the presentation will be focused on the clinical question being posed to the consultant.
  2. Persuade others about a diagnosis and plan: a shorter presentation which highlights the pertinent positives and negatives that are relevant to the diagnosis and/or plan being suggested.
  3. Enlist cooperation required for patient care: a short presentation focusing on the impact your audience can have in addressing the patient’s issues.


  1. Include only essential facts; but be ready to answer ANY questions about all aspects of your patient.
  2. Keep your presentation lively.
  3. Do not read the presentation!
  4. Expect your listeners to ask questions.
  5. Keep the limitation of your listeners in mind.
  6. Beware of jumping back and forth between descriptions of separate problems.
  7. Use the presentation to build the case for your VALUE.
  • For more “Tips” on communication skills specific to addictions treatment, click here.

  • A sample letter to “Marcia” can be found here.

  • Read two interesting papers on the subject written by Haber and Lingard.

Tell me what you think.  Let’s start talking about it…


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