Lesson 1.1 — Stop Performing RTO
The easiest way to make RTO feel artificial is to treat it as a checklist: empathy, ICE, psychosocial questions, shared decision, done. A patient-centred consultation is different. Each response should be shaped by what this patient has just said.
If you could say exactly the same sentence to almost every patient, ask yourself whether it is genuinely responding to this patient.
Case 1 — Dyspepsia and a family cancer fear
A 52-year-old man presents with six weeks of dyspepsia.
“It’s probably nothing, but my brother died from stomach cancer when he was 54.”
“Okay. Any vomiting?” or later asking, “Do you have any concerns?” as though he has not already told you.
“You mentioned your brother’s cancer. I wonder if that has been playing on your mind since these symptoms started?”
You respond to the cue at the moment it appears, invite the patient’s real concern and show that you are listening.
When you explain your assessment, return to the fear: “Coming back to the worry about your brother…” Then explain what you have found, what you are doing next and why.
Micro-skill: Use Information Twice
A useful RTO habit is to use important patient information at least twice: first to understand the patient, and later to personalise the explanation or plan. If work, caring responsibilities, pregnancy plans, medication fears or a family experience matter enough to explore, they usually matter enough to influence the plan.