Professor Samuel Menahem Consultant paediatrician and paediatric cardiologist; emeritus head, fetal and paediatric cardiac units, Monash Medical Centre; department of paediatrics and school of clinical sciences, Monash University; Australian Centre for Heart Health; Murdoch Children’ s Research Institute, University of Melbourne, Victoria.

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This information was correct at the time of publication: 13 February 2026

INTRODUCTION

EACH consultation with a patient,

whether by a GP or non-GP specialist

, involves direct communication with the patient and / or parent / guardian if the patient is a child. Improving one’ s communication skills remains a lifelong task; its benefits have been exemplified through observing our favoured teachers and mentors, and have been substantiated in the literature. 1 Paediatricians, for example, are generally skilled in examining infants and young children but may still need to acquire skills as to how best to communicate with the child as well as the parent / guardian. 2

Is it possible to conduct an interview while, at the same time, observing the interactions that occur? How does one aspire towards a therapeutic

interview: an interview that not only gathers information leading to a diagnosis and appropriate management but also aims to effect change in the patient by listening to, observing and emphatically responding to the verbal and non-verbal communications brought to the interview, as pioneered by Dr Donald Winnicott, an English paediatrician turned psychoanalyst? 3

For counselling through good communication to be credible, one requires a correct diagnosis, an appropriate management strategy and the skills to carry it out, either by the attending clinician or through an appropriate referral. 4 Improving communication with one’ s patients is an added bonus, which yields better outcomes and improves the clinician’ s personal satisfaction. 1

What then are the pitfalls of poor communication? How well does one deal with emotionally charged interviews? How does one identify the so-called non-presenting symptom and / or the hidden agenda or second diagnosis? How important is an understanding of the psychological concepts of transference and countertransference? The answers to these questions will impact on the outcome of a consultation, highlighting the importance of effective communication. And finally, what pathways are there in training and personal development to acquire these important skills?

This How to Treat attempts to address the above questions with the aim of encouraging GPs to acquire the skills that may help improve their communication with their patients.

THE CONSULTATION

MOST patient encounters involve a

single pressing presenting problem( and often other lesser issues), necessitating a review of the history and a focused examination, followed by a formulation and appropriate treatment. Reassurance or simple advice is often all that is required. At times, further investigation, medications and / or interventions may become necessary.

Most clinicians achieve competence in these skills and develop appropriate management strategies related to their daily practice. But what if there is more to the patient encounter that is not readily apparent at first sight? Often, the specific concerns raised may have a greater significance for the patients and / or their families, who have been sensitised