First minutes of the HOF consultation: what to say

The consultation doesn't begin when you look at the patient's face. It begins when they walk through the door. The first minutes decide whether they feel heard or assessed, whether they speak frankly or cautiously, and whether they leave with confidence or with doubts. The rest of the consultation is, to a large extent, a consequence of the beginning.

This page proposes an opening in five moves, easy to remember and easy to adapt to your style.

Why does the opening matter?

People seeking harmonization are usually talking about something intimate: their own image. The vulnerability is greater than in many consultations, and the patient arrives alert to every signal. A look that lingers too long on the face, a phrase like "let's see what we can do" or visible haste already says a lot.

At the same time, the opening is the best moment to gather information. Patients speak more, and more honestly, when they sense there is room. That yields a better plan and a safer relationship.

The five moves

1. Welcome

Greet them standing, make eye contact and call the patient by name. Offer a comfortable chair and, if it makes sense, water. Avoid starting behind the computer or with your head down in the patient record. That first contact costs seconds and changes how the visit is perceived.

2. Set the format

Explain what is going to happen: "Today we'll talk, I'll examine you and, if it makes sense, we'll build a plan. Nothing will be done without your decision." That sentence reduces the anxiety of patients who fear leaving with a procedure they didn't ask for.

3. Ask

Start with an open question: "What brought you here?", "What would you like to talk about today?". Avoid questions that already point to a procedure ("what do you want to have done?") or to a flaw ("what bothers you?"). For a bank of questions, see open questions for the HOF consultation.

4. Listen

Listening is the hardest part and the most valuable. Don't interrupt, don't finish sentences, don't start explaining right away. Give small signals that you are following and let the silence do its work. The method is in active listening in the HOF consultation.

5. Agree on the path

Before the exam, summarize in two or three sentences what you heard and propose the next step: "From what I understood, what bothers you most is X and you would like Y. I'll do the exam and then we'll talk about what makes sense." This summary confirms that you understood and allows immediate correction.

What not to do in the first minutes

Other frequent mistakes:

• looking at your phone or computer while the patient speaks;
• talking more than you listen;
• assuming what the patient wants from their age or appearance;
• using technical terms without explaining them;
• rushing so as "not to run behind schedule".

For vocabulary, see words to avoid in the HOF consultation.

Adjustments by patient type

Each profile has its own page: anxious patient in the consultation, patient who arrives with a ready-made request, undecided patient and companion who gives opinions.

And when does the simulation come in?

Not in the first minutes. The simulation works best after listening and the exam, when you already know what the patient is looking for. Showing it too early can anchor the expectation to an image before you understand what they really want. See presenting the projection in the consultation.

What about the medical history and consent?

The medical history can be taken at the start or after listening, depending on your routine. What matters is that it doesn't become an interrogation that tramples over the welcome. The informed consent, on the other hand, comes after the plan, with time to read, as in how to explain the consent form.

A checklist

What should you record?

Record the concern in the patient's words, what motivated the visit, the expectations stated and what was agreed as the path. This record, made in the very first minutes, gives a basis for the plan and for consent. For a complete overview, see the HOF consultation checklist.