Communication
Module
Module covers:
- Why understanding comes before explaining
- The Big Three communication principles
- Tactical Empathy — what it is and how to use it
- The Emotional Bank Account in clinical practice
- How emotion drives patient decisions
- Practical communication tips for pain consultations
Information in
before information out
Good clinical communication isn't about talking — it's about understanding first. This module teaches you how to listen, connect, and communicate in a way that builds trust and improves outcomes.
Learning
Objectives
By the end of this module you will be able to:
1
Explain why understanding a patient's perspective must come before giving information or advice
2
Define cognitive and emotional empathy and distinguish them from tactical empathy
3
Apply the Big Three principles of effective clinical communication
4
Describe the Emotional Bank Account model and how it affects patient engagement
5
Recognise how emotion shapes patient decision-making, including decisions about rehab
6
Use communication strategies that are especially effective in pain consultations
The Big
Three
Three foundational principles that underpin all effective clinical communication:
1
Understand Before Being Understood
Gather the full picture before you offer explanations or advice. Patients feel heard when you seek to understand their story first.
2
Tactical Empathy
Deliberately recognise and acknowledge what the patient is experiencing — then use that understanding to shape your words and actions.
3
People Decide on How They Feel
Patients don't make decisions purely from logic. Emotion plays a central role — including whether they follow through with treatment plans.
Understand
First
Information In Before Information Out
Before giving advice, education, or a diagnosis — make sure you truly understand what the patient has told you. This is called "seeking to understand."
Why this matters:
- Patients are more receptive to information once they feel genuinely heard
- Clinicians who rush to explain miss important context that changes their clinical reasoning
- Understanding the patient's story builds the therapeutic relationship from the first session
- People are more likely to follow a plan they feel was built around their situation
"SEEK" to understand
Common mistake: Jumping to reassurance or education before the patient feels fully understood. Even correct information lands poorly if delivered too early.
Types of
Empathy
Understanding empathy is key to using it effectively in clinical practice. There are two distinct types:
Cognitive Empathy
The intellectual ability to recognise and infer what another person is thinking or feeling.
→ Understanding what the experience is like for them
Emotional Empathy
The felt sense of sharing another person's emotional state — experiencing it alongside them.
→ Feeling what they feel
Clinical note: Both types of empathy are present in good clinicians. However, pure emotional empathy without boundaries can lead to burnout. Knowing the distinction helps you manage yourself while remaining present for your patient.
Tactical
Empathy
Tactical empathy is not about feeling sorry for someone. It's a deliberate communication skill.
What it is NOT:
Feeling sorry for them
❌
That's sympathy — it keeps distance
Putting yourself in their shoes
❌
That's projection — it's about you, not them
What it IS:
Thinking carefully about what the experience is like for them, then deliberately framing your words and actions from that perspective.
Think from their world.
Speak into it.
Emotional
Bank Account
Every clinical interaction either deposits or withdraws from the patient's trust. Think of the therapeutic relationship as a bank account.
Deposit ↑
Listening fully · Validating pain · Explaining clearly · Showing genuine care · Following through · Respecting goals
Withdrawal ↓
Dismissing concerns · Being rushed · Contradicting without explaining · Broken commitments · Minimising the patient's experience
Surplus → Trust → Better Decisions → Better Rehab Outcomes
Deficit → Resistance → Non-adherence → Poor Outcomes
How Patients
Decide
People make decisions
on how they feel.
(including you, by the way)
Providing correct clinical information is necessary — but it is rarely enough on its own. Whether a patient trusts your explanation, commits to a rehab plan, or returns for follow-up is driven heavily by how they feel during the interaction.
Logic Alone Fails When…
- Patient feels dismissed
- Fear or anxiety is unaddressed
- Emotional bank account is in deficit
- The patient doesn't feel seen
Communication Works When…
- Emotion is acknowledged first
- Patient feels understood
- There is trust in the relationship
- Information matches their readiness
Communication
& Pain
These principles apply everywhere — but they matter most in pain consultations.
Why pain is different:
- Pain is invisible — patients often feel disbelieved before they arrive
- Chronic pain is associated with fear, loss of identity, and frustration
- How you communicate about pain changes how patients experience it
- Iatrogenic harm — clinician words that worsen fear or disability — is real and preventable
Practical Tips
- Let the patient tell their full story before you ask structured questions
- Acknowledge the emotional weight before offering clinical information
- Avoid nocebo language (words that increase fear or catastrophising)
- Frame education around what the patient can do, not what to avoid
- Check what matters most to them — not just what hurts
- Match your language to their understanding, not your training
Module
Summary
Understand First
- Information in before information out
- Seek before you speak
- Full story before advice
Tactical Empathy
- Not sympathy or projection
- Think from their world
- Frame your words from their perspective
Emotion Drives Decisions
- Logic alone isn't enough
- Address feelings first
- Applies to every patient
Emotional Bank Account
- Every interaction deposits or withdraws
- Surplus = trust = better outcomes
- Deficit = resistance and non-adherence
Empathy Types
- Cognitive — understand their experience
- Emotional — feel alongside them
- Tactical — use it with intention
Pain Consultations
- Acknowledge emotion before educating
- Avoid nocebo language
- Ask what matters most to them
Communication is a clinical skill.
Train it like one.