Every practice runs consultations, and almost nobody is taught how. You learn the clinical content in school and then you learn the conversation by doing it badly a few hundred times, picking up questions from whoever you shadowed and dropping the ones that felt awkward.
The result is that most consultations are three good questions and seven improvised ones, in an order that changes depending on how the day is going. Which is fine, mostly. Until the visit where the thing you didn’t ask turns out to be the thing that mattered.
What follows is a framework rather than a script. It’s built from clinical communication research that has held up for thirty years, and it works the same whether you’re a massage therapist taking a first history, a nurse injector meeting a new patient, or a physiotherapist scoping out six weeks of treatment. If you’re specifically running skin consultations, the treatment-level version of this is our guide to the top ten things to ask during an esthetician consultation.
1. “What brought you in today?” Then nothing.
Asking is easy. The hard part is the six seconds after it, and there’s research that puts a number on exactly how badly we handle those. Investigators at Mayo Clinic recorded 112 clinical encounters and measured what actually happened when patients started talking. The clinician asked about the patient’s concerns in 36% of visits; where they did ask, patients were interrupted seven times out of ten, at a median of 11 seconds. Specialists asked less often than primary care. And the number that makes the whole thing sting: the patients who weren’t interrupted took a median of six seconds to say what they came for.
Six seconds of silence buys you the patient’s own framing of their problem, which is information you cannot get any other way. Interrupt, and you get your framing of their problem, tested against a smaller sample.
The practical version: ask, then physically do nothing. Don’t type, don’t reach for the file, don’t nod them along to speed them up. Count to six in your head if that’s what it takes.
2. “Is there anything else?” Asked until the answer is no.
Patients don’t lead with their real concern. They lead with the acceptable one.
It’s one of the best-documented patterns in consultation research: the concern raised first is frequently not the most important, and the significant one arrives late, often as the patient is standing up. The fix is to collect the full agenda before working on any of it. Ask “is there anything else you’d like to cover today?” and keep asking until you get a clean no, then decide together what fits in the time available.
It feels like it will open the floodgates. It reliably does the opposite, because the alternative, discovering item three at minute twenty-five, is what actually blows up your schedule.
3. “What do you think is going on?”
This is the I in ICE (ideas, concerns, expectations), the framework at the centre of the Calgary-Cambridge guide. It was built partly at the University of Calgary in the mid-1990s and has been taught in medical schools here and in the UK ever since, which is a long run for a communication model.
Asking what someone thinks is causing their problem does two things at once. It surfaces the belief you’ll otherwise be arguing with silently for the rest of the appointment. The patient convinced her shoulder pain is a torn rotator cuff will not hear your explanation of impingement until you’ve addressed the tear. And it tells you what she’s already read, tried, and been told, which saves you repeating it.
You don’t have to agree with the answer. You have to know it.
4. “What are you most worried about?”
That’s the C, and it’s a different question from the last one even though it sounds close. The presenting complaint is a symptom. The concern is what the symptom means to that person, and it’s rarely what you’d guess. A client with a mole is not worried about a mole; she’s worried about melanoma because her uncle had it. A patient with back pain is not worried about back pain; he’s worried about whether he can keep his job.
The concern is what the visit is actually about, and once it’s on the table, half the consultation gets shorter. Reassurance that lands on the real fear works. Reassurance aimed at the stated symptom bounces off, and the patient leaves and books a second opinion.
5. “What were you hoping we’d do about it?”
The E, and the one people skip because it feels like handing over the wheel. It isn’t. Asking what someone expected doesn’t commit you to providing it. It just means you find out about the mismatch at minute four instead of at the end, when you’ve already spent twenty minutes explaining a plan they were never going to accept.
This question is worth extra weight in any elective or cosmetic setting, where the gap between expectation and outcome is the complication. The Canadian Medical Protective Association reviewed 644 medico-legal cases involving cosmetic procedures closed between 2019 and 2023. The most common patient complaints were deficient assessment (42%) and an inadequate consent process (38%). Peer experts most often criticised the consent process and the documentation. Almost none of that is about technique. It’s about what was said in the room, and whether anyone wrote it down.
The CMPA’s own advice on this is the part I’d tape to a wall: telling patients what to expect isn’t enough, so get them to reflect their expectation back to you. Which is question ten.
6. “When did it start, and what makes it better or worse?”
Here’s the clinical core, and it’s the part most practitioners are already good at. The value of putting it fifth or sixth rather than first is that by now you know what you’re taking a history of.
Whatever discipline you’re in, a structured frame beats an improvised one, because the improvised version drops items when you’re tired. If you work with pain, PQRST (provocation, quality, region, severity, timing) gives you the same sweep every time, and it turns a narrative into fields you can chart and trend. Other disciplines have their own; the point is having one.
Insist on two things. Onset with an actual date or event rather than “a while ago.” And what makes it better or worse, which is often more diagnostic than any description of the symptom itself.
7. “What else should I know about your health?”
Medications, conditions, allergies, previous surgeries, previous treatment for this problem, and what happened.
Every practice thinks it asks this. Most ask it once, at intake, and then rely on a form the patient filled in on a clipboard in 2024. That’s a snapshot of a person who no longer exists. Medications change, diagnoses arrive, someone starts a blood thinner in the spring.
Break it into specific prompts, because “any medical history?” reliably gets a reflexive no:
- Medications, including the ones that don’t feel like medications. Supplements, over-the-counter painkillers, anything topical, anything prescribed by someone else for something unrelated. Fish oil and high-dose vitamin E behave like anticoagulants and nobody volunteers them.
- Anything that’s changed since we last spoke. For returning clients this replaces the entire history question, and it takes fifteen seconds.
- Who else is treating you for this? Other providers, other plans, and whether anyone needs to be talking to anyone.
8. “What does a good outcome look like to you, and by when?”
Ask for a specific, observable thing and a timeframe. “Feeling better” is not an outcome; “getting through a shift without taking anything” is.
This question is where you find out whether your plan and their goal are the same shape. Someone whose goal is one pain-free week before a wedding needs a different plan from someone managing a chronic condition over a year, even if the assessment is identical.
It’s also where you say the unglamorous thing out loud. If the realistic answer is three months and six sessions, say three months and six sessions. If the honest answer is that this isn’t something you treat, say that. Patients almost never resent an accurate forecast. They resent a cheerful one that turns out to be wrong, and that resentment is what a complaint is made of.
The other half of expectation-setting is price, and it belongs in the consultation rather than at the front desk afterwards. The CMPA’s guidance for cosmetic procedures lists the breakdown of charges and additional fees among the things that should be discussed as part of consent. Someone who learns the real number after committing has a legitimate grievance even when the clinical work was perfect.
9. “What are the options, including doing nothing?”
Consent in Canada is not a signature on a form. Since the Supreme Court’s decision in Reibl v. Hughes in 1980, the standard has been what a reasonable person in the patient’s position would want to know, and the CMPA’s consent guidance sets out what that includes: the nature of the proposed treatment, its expected benefits, material risks including rare but serious ones, the alternatives, and the consequences of declining. Courts have applied a higher disclosure standard to elective and cosmetic work, where the intervention isn’t medically necessary in the first place.
The “do nothing” branch is the one most often left out, and leaving it out is what turns a discussion into a pitch. Say what happens if they wait. Sometimes the answer is “not much, and that’s a reasonable choice,” and saying so buys you more trust than any amount of persuasion.
Then document the conversation, not just the outcome. A signed form proves a form was signed. A note recording which risks you named and what the patient said back is the thing that holds up. Our guide to consent forms and before-and-after photos covers the version of this that involves imaging, where consent to treat and consent to publish are two separate permissions and should never share a checkbox.
10. “Can you tell me the plan in your own words?”
End every consultation by making the patient say the plan back to you, because the evidence on what they’d otherwise retain is blunt. Between 40% and 80% of medical information is forgotten immediately, and nearly half of what is retained is retained incorrectly. That’s Kessels’ review in the Journal of the Royal Society of Medicine, and one of the most replicated findings in the field. Everything you carefully explained is evaporating while the patient puts their coat on.
Teach-back is the correction, and it’s Tool 5 in AHRQ’s Health Literacy Universal Precautions Toolkit, recommended alongside the Institute for Healthcare Improvement as a baseline practice rather than a special-case one. The rule is simple: never ask a question that can be answered yes. “Does that make sense?” is not teach-back. “I want to be sure I explained that well. What’s the plan for the next two weeks?” is.
Beyond the comprehension gain, it catches errors you’d never otherwise see. People teach back the wrong interval or the wrong warning sign, and they do it with total confidence. Better to hear that in the room than in a phone call on Saturday.
The part nobody plans for: writing it down
Ten questions produce a lot of information, and the record is where most of it dies.
Look again at what the CMPA found in those 644 cosmetic cases: the two things peer experts criticised most often were the consent process and the documentation, each in roughly a quarter of cases. Neither of those is a skill problem. They’re both a record problem.
The trouble is that documenting well and consulting well pull in opposite directions. Type during the visit and you’re looking at a screen during the six seconds of silence that made question one work. Type after the visit and you’re doing it from memory, between clients or at nine at night, and detail decays fast. A time-and-motion study in Annals of Internal Medicine clocked clinicians spending nearly two hours on documentation and desk work for every hour of direct patient contact. Nobody chose that trade; it accumulated.
How Zdrovia helps with consultations
Zdrovia is practice software built for Canadian clinics, and the part of it that matters most to a consultation is the AI Scribe: it writes the consultation note for you, while you run the consultation.
You hit record and put the laptop down. It transcribes live, and when you finish it reads the transcript against the chart you’re already in and proposes the note:
- Prose under your own headings. Not a generic SOAP dump. It fills the template you already use, in the sections you already have.
- Structured fields, filled in. A pain score, a range-of-motion figure, a medication change said out loud lands in the field it belongs to instead of being buried in a paragraph where nobody can trend it.
- Nothing written without your tick. Every proposal is a checkbox you accept or reject. Fields nobody mentioned are left empty rather than invented.
- Every word traceable. The transcript is aligned to the audio word by word, so you can click any word and hear it said. That is the difference between a note you’d defend and a note you’d hope nobody reads.
- Audio is never stored. It is transcribed and discarded.
Which is the answer to the two problems in this article that questions can’t fix. The six seconds of silence in question one only works if you aren’t typing through them. And the record the CMPA’s peer experts kept criticising — what was discussed, what was consented to, what the patient said back — only exists if writing it down stops competing with the appointment.
Pair it with Smart Blocks and the numbers from your consultations trend across visits instead of sitting in prose you have to reread.
The AI Scribe is free on every Zdrovia account while it’s in beta. Book a walkthrough and we’ll run a consultation through it with your own template.
The one-page version
- What brought you in today? Then say nothing for six seconds.
- Anything else? Keep asking until the answer is a clean no, then prioritise together.
- What do you think is going on? Their theory, not yours.
- What worries you most? This is what the visit is actually about.
- What were you hoping we’d do? You want the mismatch at minute four, not minute forty.
- The structured history: onset with a real date, and what makes it better or worse.
- What else should I know about your health? Medications, changes, other providers.
- What does a good outcome look like, and by when? Say the price out loud here too.
- What are the options, including doing nothing? Then document the discussion, not just the signature.
- Tell me the plan in your own words. Never a question they can answer with yes.
Nine of these cost you nothing but restraint. The tenth costs about forty seconds and is the only one that tells you whether the other nine worked.
Ask them well, and the only thing left is writing it down. Book a walkthrough of Zdrovia and see what a consultation looks like when the note keeps up on its own.