Building Rapport in the First Consultation: The Art of Connection

2a Building rapport in the first consultation the art of connection



Building rapport is a vital aspect of establishing a strong therapeutic relationship with patients. In the first consultation, practitioners have a unique opportunity to create a foundation of trust and understanding. This blog will delve into thirteen essential points to consider when aiming to build rapport during that crucial initial meeting.

1. Where possible, meet at eye level:

Starting the consultation by positioning yourself at eye level with the patient when you introduce yourself, establishes a sense of equality and respect. It conveys that you value their perspective and are ready to listen attentively.

This all happens at an unconscious level in the brain of the patient. Where possible, work out ways to make the first contact as close to eye contact as possible.

2. Eye contact for 4 seconds:

Maintaining eye contact for about four seconds demonstrates active engagement and signals that you are present and genuinely interested in what the patient has to say. This simple gesture can foster a deeper connection.

If you struggle with this, practice in any social setting or even going through the checkout in a supermarket.

3. Ask for permission to do computer notes:

Acknowledging the patient’s privacy and seeking permission before taking notes on a computer or any other device shows respect for their personal information and promotes an open and collaborative environment. I’ve never met any patient who has refused this request.

As simple as it seems, this request provides the patient with a small sense of control in the consultation.

4. Respect their information gathering to date and manage your ‘righting reflex’:

Recognise and honour the efforts the patient has made to gather information about their condition. Avoid the temptation to immediately correct or dismiss their findings. Be curious about what they have found out and where the information has come from.

5. Find out what information the patient wants from you:

Instead of jumping into the ‘education’ mode, Inquire about the specific information the patient is seeking from you. By understanding their expectations, you can tailor your responses to address their needs effectively.

Especially in the initial consultation, the patient will remember very little of what you tell them. You’ll be wasting valuable time that could be used better elsewhere in the consult.

The only benefit is that you will feel good!

6. Encourage them to share their concerns or fears:

Create a safe space for patients to express their concerns or fears openly. Active listening and non-judgmental responses will help alleviate anxiety and build trust.

7. Be aware of sensory acuity – yours and theirs:

Be attuned to both your own sensory experiences and the patient’s non-verbal cues. Pay attention to tone of voice, body language, and facial expressions, adjusting your approach accordingly.

Most communication breakdown comes from the tone of voice rather than the words spoken.

8. Be cautious with saying “I understand” – sympathy versus empathy:

While expressing understanding is important, be mindful of the distinction between sympathy and empathy. Rather than assuming you fully comprehend their experience, show empathy by acknowledging their emotions and validating their feelings.

In the majority of cases the clinician really has very little understanding of the patient’s life and and how they are processing the situation they’re in. If you say ‘I understand what you must be going through” the patient is likely to be thinking that you have no idea.

If you say “I have no idea what you must be going through, (and list the know facts) but I’m here to help and support you in any that I can”, you will gain more respect and trust from your patient.

9. Be conscious of question fatigue:

Be mindful of the number and complexity of questions you ask. Too many questions can be overwhelming for patients, impeding their ability to fully engage in the conversation. Using labels and reflections, both simple and complex, you will avoid question fatigue and still get the information you need.

10. Practice effective listening with the use of labels, simple and complex reflections:

Active listening involves skillful use of labels, simple reflections, and complex reflections. These techniques demonstrate that you genuinely hear and understand the patient’s concerns, fostering rapport and trust.

11. Avoid using jargon:

Speak in plain language and avoid excessive use of medical jargon. Communicating clearly and concisely ensures that patients can understand the information you provide, empowering them to make informed decisions about their care.

12. Involve the patient in goal setting using WFO and treatment plan proposals with ‘no-orientated questions’:

Engage patients in the goal-setting process, using the Well Formed Outcome (WFO) approach. Seek their input and preferences, allowing them to play an active role in shaping their treatment plan. Giving them the permission to adapt the treatment plan to suit their current circumstances will help with adherence.

13. Be willing to act on what your patient wants – the art of negotiation even in the first session:

Demonstrate flexibility and willingness to accommodate the patient’s desires and preferences whenever possible. Engage in a constructive negotiation process, ensuring their needs are met while considering professional expertise and limitations.


Building rapport in the first consultation is essential for establishing a strong therapeutic alliance. By employing these thirteen points – from active listening and empathy to effective communication and involvement in the decision-making process you will provide the basis on which the patient wants to come back and see you.

Where to from here for Thinking.Physio?

Skills practice and reflection will be the cornerstone of my training. I am available for both in person and Zoom PD for your group.

If you have a staff member who is struggles communicating with patients, you might be interested in one-on-one coaching for him/her. I take on a limited number of clients each year.

If you would like to engage me to work with your staff or coach a member of your team, click here so that you can schedule a time to discuss your specific training needs.

Contact me to find out when I will be in your city and available for LIVE professional development.

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