Communication In Consultations Research Articles

How is diagnostic uncertainty communicated and managed in real world primary care settings?

BackgroundManaging diagnostic uncertainty is a major challenge in primary care due to factors such as the absence of definitive tests, variable symptom presentations and disease evolution. Maintaining patient trust during a period of investigative uncertainty, whilst minimising scope for diagnostic error is a challenge. Mismanagement can lead to diagnostic errors, treatment delays, and suboptimal patient outcomes.ObjectiveOur aim was to explore how UK primary care physicians (GPs) address and communicate diagnostic uncertainty in practice.DesignThis qualitative study used video and audio-recordings. Verbatim transcripts were coded with a modified, validated tool to capture GPs’ actions and communication in primary care consultations that included diagnostic uncertainty. The tool includes items relating to advice regarding new symptoms or symptom deterioration (sometimes called ‘safety netting’). Video data was analysed to identify GP and patient body postures during and after the delivery of the management plan.ParticipantsAll patient participants had a consultation with a GP, were over the age of 50 and had (1) at least one new presenting problem or (2) one persistent problem that was undiagnosed.ApproachData collection occurred in GP-patient consultations during 2017–2018 across 7 practices in UK during 2017–2018.Key resultsGPs used various management strategies to address diagnostic uncertainty, including (1) symptom monitoring without treatment, (2) prescribed treatment with symptom monitoring, and (3) addressing risks that could arise from administrative tasks. GPs did not make management plans for potential treatment side effects. Specificity of uncertainty management plans varied among GPs, with only some offering detailed actions and timescales. The transfer of responsibility for the management plan to patients was usually delivered rather than negotiated, with most patients confirming acceptance before concluding the discussion.ConclusionsWe offer guidance to healthcare professionals, improving awareness of using and communicating management plans for diagnostic uncertainty.

PATIENTS’ AND PHYSIOTHERAPISTS’ PERSPECTIVES OF TREATMENT OUTCOMES AND EXPERIENCES IN EPISODES OF LOW BACK PAIN

Statement of purpose of study and backgroundAs the treatment of low back pain (LBP) continues to evolve, there is greater recognition of the importance of optimising the therapeutic relationship to better deliver improved patient outcomes. Contextual effects, such as communication, have been shown to influence the therapeutic relationship, but it is not known how these factors evolve over time. This study analysed interviews from two studies (one cross-sectional and one longitudinal) to explore patients’ and physiotherapists’ perspectives of treatment outcomes and experiences in episodes of LBP in the same dialogic space. The objective was to explore the alignment between these perceptions to identify factors that influence the therapeutic relationship over time.Summary of methods used and resultsTwo secondary thematic analyses were undertaken, one analysing cross-sectional data and the other analysing longitudinal data, from an existing data set from the programme: “Exploring the relationship between communication and clinical decision-making in physiotherapy consultations for back pain”. All data were thematically analysed and organised using a framework approach.Six themes emerged from the cross-sectional data reporting consistency of opinion in the initial consultation stages, but highlighting inadequate patient involvement in shared decision making. Four main themes emerged from the longitudinal data, all of which reported interactional fears and anxieties identified on both the parts of the patient and the physiotherapist.ConclusionThese findings suggest that failing to involve the patient in adequately personalised treatment from the initial consultation may lead to diagnosis hunting and stereotyping behaviours within the therapeutic relationship, in turn leading to increased health resource usage.Conflicts of interestNoneSources of FundingThe primary data set was collected in a research programme funded by Arthritis Research UK (now Versus Arthritis).

Risk Communication on Zoonoses and Antimicrobial Resistance-How Do Exotic Pet Owners Perceive the Communication of Their Veterinarians?

Exotic animals traded and kept as pets can transmit a variety of diseases to humans and other animals, and vice versa. Therefore, it is essential for pet owners, particularly vulnerable groups, to be informed about associated risks. Veterinarians play a crucial role in informing pet owners about health risks associated with zoonotic pathogens and antimicrobial resistance (AMR) and should, therefore, have good communication skills to effectively transfer information to pet owners. Thus, exotic pet owners in Germany were surveyed on animal husbandry, veterinary consultation and risk communication. To evaluate the perception of communication, a self-developed questionnaire was used to derive a communication score. The perception of veterinarian communication received a high average score showing a high level of satisfaction. The duration of the veterinarian-client relationship was associated with better communication perception, and the frequency of communication on zoonoses and AMR was associated with the presence of a permanent veterinarian. However, the results indicated that the frequency of disseminated information on zoonoses and/or AMR from veterinarians was lower than desired by the pet owners. Therefore, more educational material on zoonoses and AMR should be made available, and the awareness concerning risk communication should be increased by further education and training at universities.

Examining the role of pre-visit anxiety on patient uncertainty and breast cancer patient-provider communication.

Effective communication between cancer patients and providers is critical for addressing psychological distress, reducing uncertainty, and promoting patient well-being. This is particularly relevant during medical appointments that may elicit uncertainty, such as surgical consultations for newly diagnosed women with breast cancer. This study aimed to evaluate how pre-appointment anxiety and illness uncertainty affect patient-provider communication in breast cancer surgical consultations and subsequent post-appointment well-being. Breast cancer patient anxiety has been studied as an outcome of provider communication, though less is known about the extent to which preexisting anxiety or uncertainty act as antecedents to effective patient-provider communication. This study analyzed videorecorded breast cancer surgical consultations (N = 51) and corresponding patient surveys to understand how pre-appointment anxiety influences pre-appointment patient uncertainty, patient-provider communication during the appointment, and subsequent post-appointment uncertainty. The proposed model achieved good fit to the data such that more pre-appointment anxiety was associated with more pre-appointment uncertainty, more pre-appointment anxiety was associated with more empathic opportunities per minute, and more empathic opportunities were associated with less post-appointment uncertainty. Results indicate breast cancer patients with anxiety pre-appointment are at-risk for more illness uncertainty and are more likely to explicitly provide empathic opportunities. This supports the need for added attention to empathic opportunities to not only address patients emotionally but to also assess whether a patient may be at higher risk of having preexisting anxiety.

The Evolution of Communication Consulting: A Long-Term Comparison of Service Quality in Strategic Communication

ABSTRACT Communication leaders and their teams are seldom able to handle the broad range of challenges within their area of responsibility by themselves. They rely on agencies as an external workbench and as specialists for new or seldom used practices. More importantly, they seek advice from communication consultants to understand challenges, and to identify opportunities for action. The increasing demand for such services has pushed prices and intensified the debate about their quality. Surprisingly, research on communication consulting and its quality is sparse. The first empirical studies were conducted just 10 years ago. In light of dynamic industry developments, the question arises regarding how the understanding and perceptions of communication consulting quality has evolved. To this end, a comparative study surveyed a total of 422 communication agencies in 2013 and 2023 on the relevance, factors, assurance, and showcasing of consulting quality. The results reveal that the importance of consulting quality is still high, but underlying conditions and implementation of quality have changed considerably. As the first in-depth and long-term exploration of this phenomenon, this research helps to shed light on a highly relevant but underexplored facet of strategic communication. It informs practice and offers numerous starting points for future research.

Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach.

To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.

“You Have to Find a Way for This Child to Be at the Center”: Pediatric Cardiologists’ Views on Triadic Communication in Consultations on Congenital Heart Defects

ABSTRACT Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children’s cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists’ views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents’ emotional needs, and (3) the physician’s role as mediator between parent(s) and child. In each category, three elements are discussed: The physician’s agenda, obstacles and challenges, and the physician’s practical methods. Physicians strongly support children’s involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents’ and children’s needs.

Content and Duration of Doctor-Patient Communication in Outpatient Oncology Follow-Up Consultations in China.

Purpose This study aimedto analyze the content of counseling between cancer patients and physicians during outpatient follow-up, assess the duration of different communication content, and explore the influencing factors. Patients and methods We observed consecutive cancer patients without a first diagnosis of malignancy who presented to the oncology outpatient clinic of a public hospital from October through December 2023. A structured observation form was used to record the content and duration of doctor-patient communication. All variables were electronically recorded and stored on a data management platform. Multiple linear regression was used to examine the determinants of consultation duration. Results Our study included 620 cancer patients, of whom 281 individuals had distant metastasis. The average consultation duration for 620 cancer patients was 4.85 minutes (standard deviation of 3.09 minutes). The category of doctor-patient communication was routine outpatient follow-up, involving 182 patients, with an average consultation duration of 3.81 minutes (standard deviation of 2.24 minutes). The main communication content for 51 patients was about the admission procedures, with an average consultation duration of 3.00 minutes (standard deviation of 1.92 minutes). For 67 patients, the primary communication involved the prescription of anti-tumor medications, with an average consultation duration of 3.70 minutes (standard deviation of 2.30 minutes). Symptom control discussions were the main communication content with 107 patients, with an average consultation duration of 5.91 minutes (standard deviation of 3.44 minutes). The main communication content of 24 patients involved medical insurance reimbursement, with an average duration of 7.75 minutes (standard deviation of 4.63 minutes). Consultations accompanied by caregivers and the presence of metastatic tumors were positively associated with consultation duration, whereas female patients with genital malignancies were negatively associated with consultation duration. Communication about symptom management and communication about medical insurance reimbursement waspositively associated with the duration of medical consultations. Communication about administering the formalities requisite for patient admission was negatively associated with the consultation duration. Conclusion We classified the main contents of doctor-patient communication in the oncology outpatient clinic and found that the contents of doctor-patient communication tended to be monotone and systematized. Oncology outpatient models should consider the integration of caregiver involvement. The reason for the shorter outpatient consultation duration in female patients of cancer primary in the reproductive system needs further investigation. The intricate medical insurance reimbursement process poses an increasing time challenge for outpatient clinicians. In addition, the adequacy and effectiveness of symptom management services provided to cancer patients during oncology outpatient follow-up requirefurther evaluation and review.

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

No additional risk of congenital anomalies after first-trimester dydrogesterone use: a systematic review and meta-analysis.

Gynecological cancer survivors' experiences with sexual health communication in nurse-led follow-up consultations.

Gynecological cancer and its treatment may cause sexual difficulties in terms of physical and psychosocial health. Considering the essential role that nurses play in cancer care, they are well positioned to be ideal providers for addressing sexual health concerns in the follow-up phase of gynecological cancer. The aim of this study was to gain in-depth knowledge of how gynecological cancer survivors experience sexual health communication in nurse-led follow-up consultations. Using a qualitative hermeneutic approach, we conducted individual semi-structured interviews with 17 women from five different hospitals in Norway between April 4, 2022, and June 2, 2022. The women participated in a large intervention study on cancer follow-up that included sexual health as one of several topics addressed by trained nurses in three consultations in the first year of follow-up. A five-stage Gadamerian-inspired research method was utilized for data collection and analysis. We identified three themes: (1) the importance of nurses listening to the women's own perceptions of sexuality, (2) post-treatment sexual challenges influence the women's need to communicate about sexual health, and (3) nursing communication can help women regain their sexual health. Women who have undergone treatment for gynecological cancer find communication with trained nurses regarding sexual health beneficial. We recommend integration of trained nurses in the follow-up team. The nurses should adjust communication according to each gynecological cancer survivor's unique understanding of sexuality and inform women with sexual health concerns at that end of treatment, that sexual health can improve during follow-up.

Virtual care in the health care system: A concept analysis.

Health care providers need a better understanding of virtual care to recognise and use it for service delivery. To provide a more comprehensive definition of the concept of virtual care. This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.

Personalization reactance in online medical consultations: effects of two-sided personalization and health topic sensitivity on reactance

Abstract Personalization strategy in commercial contexts has often been criticized for eliciting individuals’ reactance. Will this happen to physician–patient communication in online medical consultations (OMCs)? Two experiments attempted to probe the direct, indirect, and conditional effects of personalization on reactance in OMC. Specifically, perceived threats to freedom and perceived physician caring were examined as two mediators underlying the relationship between personalization and reactance. Health topic sensitivity was investigated as a moderator. Results from both studies revealed that there was no main effect of personalization on reactance, yet personalization induced perceived threats to freedom and perceived physician caring, which affected reactance in a way that might cancel out each other. The effects of personalization (versus depersonalization) on perceived threats to freedom and reactance were more salient at the lower level of health topic sensitivity. These suggest that personalization with its two-sided nature exerts both desired and undesired influences and health topic sensitivity can be a prominent contextual factor in personalization reactance during OMC.

The Art of the Consult Call: Improving Communication Through Shared Mental Models.

The Accreditation Council for Graduate Medical Education cites effective communication with physicians as a core competency for emergency medicine (EM) residents. However, there is no standardized curriculum dedicated to communication beyond practice in the clinical setting. We developed a 1-hour EM didactic session on effective consultations using experiential education principles. Learners were placed in pairs of one junior learner and one senior learner. The junior learner performed a mock phone consultation using an EM patient case; the senior learner completed an online evaluation, assessing the junior learner on 13 core components of a successful consult call, based on Kessler's 5Cs consultation model. Subsequently, learners participated in an intervention, which included an artistic activity and facilitated debrief, connecting their reflections to clinical practice. Postintervention, the same paired learners completed a second mock consultation call and reevaluation. Finally, learners completed a feedback survey. Fifteen pairs completed both the pre- and postintervention evaluations. Of the junior learners simulating the consultation call, 47% were clinical medical students, and 53% were first-year EM residents. Preintervention, learners completed a mean of 51% of core consult call components compared to a mean of 84% postintervention. This 33% improvement was statistically significant (p < .001; 95% CI, 19.9-46.1). Eight participants completed the feedback survey; 100% agreed or strongly agreed with positive statements regarding overall session content. This engaging interactive session utilizing a mock communication exercise, unique artistic activity, and guided reflection can effectively increase junior learners' phone consultation communication skills.

Consideration of First Nations’ cultural values in mine site rehabilitation by environmental professionals

Rehabilitation of mined land on First Nations’ country after mine closure must achieve particular criteria to be considered successful. Generally, these conditions are based on achieving a habitable condition that is more or less similar to analogue sites or to the pre–mining state. Rehabilitating a site to a habitable condition requires the restoration of cultural values, as well as environmental and economic values. This study investigates the extent to which First Nations’ cultural values are considered in mine rehabilitation in northern Australia. Interviews were conducted with environment professionals who had experience rehabilitating mine sites on First Nations’ land in the Northern Territory, Australia. The participants were asked about their experiences restoring First Nations’ cultural values to mined land. Thematic analysis found six main themes: “Values” (which need to be restored); “Planning” (of rehabilitation activities); “Impediments/barriers” (to successful rehabilitation); “Solutions” (to the barriers); “Traditional Owners” and “Principles”. This study shows that mining environmental professionals argue that, with suitable political and corporate support, many cultural values could be restored. However, it was generally agreed that government oversight and regulation in relation to reinstatement of First Nations’ cultural values needed to be improved. Several participants suggested that greater consideration should be given to closure plans generally, to financial means to carry out rehabilitation, and specifically to planning to identify and address the rehabilitation of First Nations’ cultural values prior to approval. Other findings were also that First Nations’ cultural values and environmental values are closely aligned, and that consultation and effective communication with Traditional Owners are the key to integrating awareness of First Nations’ cultural values into mine rehabilitation practices.

Impact of a training program on hospital pharmacists' patient-centered communication attitudes and behaviors

BackgroundEffective communication that integrates the value of patient-centered care is important in healthcare encounters. Communication skills training (CST) has been indicated as effective in improving patient-centered communication behaviors. However, there is a paucity of studies on the impact of CST among Malaysian hospital pharmacists. ObjectiveThis study aimed to evaluate the effects of a patient-centered CST program on patient-centered communication scores, communication self-efficacy, and attitudes toward concordance among pharmacists in public hospitals. MethodsA communication skills training (CST) program was conducted among hospital pharmacists. This training intervention was developed based on patient-centered communication frameworks and techniques, namely the Four Habits Model and motivational interviewing. A pre-test/post-test quasi-experimental design was implemented for the evaluation. Pharmacists underwent pre-test/post-test audiotaped simulated consultations and completed questionnaires, including the Revised United States–Leeds Attitudes Toward Concordance scale (RUS-LATCon) and Communication Self-Efficacy scale. The Four Habits Coding Scheme (FHCS) was used to evaluate patient-centered communication scores from the audiotapes, and the Wilcoxon signed-rank test was used to analyze for differences in the pre- and post-intervention scores. ResultsA total of 38 pharmacists from four tertiary hospitals participated in this study and completed the pre-test. However, due to the impact of COVID-19, only 23 pharmacists completed the post-test data collection. Improvements were noted in the FHCS scores post-training, including items related to exploring patients' concerns, acceptability, and barriers to treatment. Based on the questionnaire, there was an improvement in recognizing patients' needs and potential medication uncertainty and an increase in the overall communication self-efficacy scores after the training. ConclusionsCST may help improve the adoption of patient-centered communication in pharmacists' consultations with patients.

1059-P: Spotlight-AQ RCT and AI Results—Improving Physical and Mental Health Outcomes for Adults with Type 1 or Type 2 Diabetes

Background: Existing therapeutic interventions are well known, yet most people with diabetes do not consistently achieve blood glucose targets for optimal health, despite the large range of treatment options available. Aim: To explore the efficacy of a novel clinical intervention addressing physical and mental health within routine consultations across healthcare settings. Methods: A multi-centre, parallel group, individually randomised trial comparing consultation length in adults with T1D or T2D for ≥6 mths to the Spotlight Consultations platform compared to usual care. Secondary outcomes: HbA1c and validated measures of depression, diabetes distress, anxiety, functional health status and HCP burnout. Results: n=98 adults with T1D or T2D; any HbA1c and receiving any diabetes treatment participated (n=49 intervention). Consultation duration for intervention participants was reduced in intervention consultations by 0.5-4.1 mins (3-14%) versus no change in the control group (-0.9 - +1.28 mins) across 15 and 30 consultations. HbA1c improved in the intervention group by 6mmol/mol (range 0-30) versus control group 3mmol/mol (range 0-8). Moderate improvements in psychosocial outcomes observed in intervention group: functional health status; reduced anxiety, depression and diabetes distress; improved well-being. None were statistically significant. HCPs reported improved communication and greater focus in consultations. Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels. Conclusion: Spotlight-AQ was associated with shorter, more useful consultations; with improved HbA1c and moderate benefits on psychosocial outcomes. Results reflect the importance of a biopsychosocial approach to routine care visits. Spotlight-AQ is viable across healthcare settings for improved outcomes. Disclosure K.Barnard: Advisory Panel; Abbott Diabetes, Roche Diabetes Care, Sanofi, Consultant; LifeScan Diabetes Institute, Tandem Diabetes Care, Inc., Research Support; Novo Nordisk. R.C.Kelly: None. L.Cohen: None. E.Barnard: None. Y.Liu: None. P.Phiri: None. O.Mendez: None. H.Price: Consultant; AstraZeneca, Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. Funding Southern Health NHS Foundation Trust

A Maturity Model for Content Strategy Development and Technical Communicator Leadership

While technical communication consultants and researchers agree that content strategy requires attention to both customer needs and business goals, we found no evidence that technical communication educators promote an accurate understanding of business goals among their content strategy students. Through industry–academia collaboration, we integrate two existing models, using content tactics within organizational characteristics that define the maturity level of an organization's content operations. Analyzing the current state of maturity for each characteristic highlights gaps that can define a content strategy with prioritized tactics and, ultimately, encourages the growth of technical communicator leadership and the empowerment of our profession.

The Value of Communication Consulting for Public Authorities

The system of communication management of public authorities faces the task create and support a positive image in order to increase the index of citizens’ trust in the government institution of the country as a whole. Due to the of problems related to the lack of control of information flows and a low level of trust in public authorities, the successful completion of this task it is not always possible through internal human and expert resources. In solving such problems, it is important to involve external consultants who, using the expertise and experience, should increase the effectiveness and ensure the effectiveness of communication solutions. In this paper, the author actualises the importance of the use of communication consulting for public authorities, and draws out the key communication problems of the institution together with the applied tools of communication consulting.

The co-construction of empathic communication in interpreter-mediated medical consultations: A qualitative analysis of interaction

Current interpreter training programs pay increasingly more attention to the intricacies of the clinical context, such as doctors and patients’ communicative goals. However, to date, the conduit model remains influential when it comes to interpreters dealing with other participants’ emotions and their own emotions in interpreter-mediated consultations (IMCs). Consequently, establishing a good doctor-patient relationship by means of empathic communication (EC) might be jeopardized in IMCs. During EC, patients express their emotional or illness experiences to which doctors convey their empathic understanding. This study aimed to assess how doctors, patients, and interpreters verbally co-construct EC and the interpreter’s effect on this process. We analyzed 7 authentic IMCs using the Empathic Communication Coding System, as previously adapted for IMCs. We identified empathic opportunities (EOs) and empathic responses (ERs) as expressed by patients/doctors, and as rendered by interpreters. Our results showed that EC is the result of an interactive and collaborative process among all participants in IMCs. That is, the interplay between participants’ communicative actions determines how patients’ expressed lived experiences are addressed in IMCs. Our findings suggest that interpreters hold a central position in this process as they initiated EC about the patient’s illness experience and exerted control over the ways in which statements were rendered (e.g., interpreters omitted and altered original statements). In addition, our results indicated that EC in IMCs might be compromised by doctors and interpreters’ communicative actions.

What To Say When You Don't Know What to Say

Each "Communication Corner" essay is self-contained; however, they build on each other. For best results, before reading this essay and doing the exercise, go to the first essay "How an Ugly Duckling Became a Swan," then read each succeeding essay. Formal public speaking is when people are invited to come to hear what you have to say and for which you usually have plenty of time to prepare. Impromptu public speaking is when you are asked to say something of consequence at a moment's notice. For example, as a student during a class, as an employee during a company meeting, as a participant in a public forum, etc. On the internet, you can find loads of tips and tactics for successfully handling impromptu speaking. Here we present a tactic you won't find on the internet because it was invented (or rather discovered) by Philip Yaffe, Ubiquity's very own communication consultant, and has never before been published.