The First Few Seconds Set the Tone
Buchi Neita, PA-C, and Shanna Miranti, PA-C, open by naming a gap they both experienced: bedside manner is one of the most critical facets of practicing medicine, yet PA school never formally taught it. As Miranti points out, patients form an impression of a clinician's competence within the first few seconds of the encounter, long before any diagnosis is made.
Neita stresses that new graduates tend to fixate on getting the diagnosis and treatment plan right while forgetting the most critical part of the encounter: how the patient actually feels about you. Body language does the heavy lifting here. Walk in, introduce yourself, smile, and ask for help pronouncing a name you can't quite get right. If you're running behind, a quick thank-you for the patient's patience goes a long way before diving in.
One habit Neita calls the single biggest change to her patient encounters: sit down. As soon as she washes her hands or sanitizes, she sits face-to-face at eye level and makes direct eye contact. Sitting signals that you're not rushing and not impatient. Miranti, who is six-foot-one, intentionally sits so the patient is at a higher level than she is, giving them the sense of an advantage. Both note there's evidence that standing over a patient can be perceived as condescending.
Remember the Vulnerability in the Room
Miranti reminds listeners that the derm patient is often sitting in a cold room, sometimes undressed or in a gown, worried about something they can't see the way you can. Ripping off a gown and diving straight into the exam without making contact first can feel scary and intimidating.
There's also the invisible backstory. As Neita explains, this visit is rarely a chance encounter for the patient. They may have waited weeks to months, chased referrals, taken time off work, and traveled long distances. Acknowledging that reality shapes how you enter the room.
Even when the medical assistant has already taken the history, both hosts re-ask the key question: are there any specific spots you're worried about, or anything you really wanted to accomplish today? Miranti notes patients often open up more to the provider than to the MA, and that brief repeat gives you a moment to sit, face them, and help them feel comfortable.
A Consistent, Respectful Exam
Neita performs her exam the same way every time when she can, going from scalp to toe, while staying attuned to anxious patients. For nervous patients, she asks permission before exposing an area or looking beneath undergarments, prioritizing comfort. Miranti uses a similar script, telling patients she's starting at the top and working down to the toes, and asks permission before moving hair, braids, extensions, or a hairpiece, sometimes using a little humor to set the tone.
Both weigh in on the power of touch. Miranti prefers to skip gloves unless she's concerned about something potentially infectious, because the touch point helps build connection. She closes even a completely normal skin exam with a hand on the shoulder or a pat on the forearm so the patient knows she's present with them.
Every visit ends with an open door: are there any questions or concerns we didn't address today? When a big-ticket issue like hair loss surfaces at minute 30, Neita reframes rather than rushes. She tells patients she's meticulous about hair loss, wants a thorough history and lab work, and schedules dedicated time to return. Patients respect the honesty and almost always come back because they want that focused time.
Trust, Honesty, and Shared Decisions
Don’t dismiss concerns that seem minor to you. Neita uses post-inflammatory hyperpigmentation as the example: you might clear a patient's acne or eczema completely, but if the discoloration that bothers them most is left unaddressed, they may not trust that you're qualified. Addressing the patient's actual primary concern at the first visit builds trust.
It's also okay not to have the answer. Neita advises telling patients when you're unsure, laying out the differential, and voicing a concrete plan: biopsy, KOH, swab, and a return visit to reevaluate. Even if therapy fails, the patient trusts that you're putting in the effort. Miranti, who has been in practice 23 years, reassures new grads that no one knows it all on day one, and she has no reservations about bringing in her supervising physicians, which patients often find reassuring.
The hosts land on shared decision-making as the throughline. In an era where patients turn to social media, family, and friends for advice, Neita urges clinicians to ask what patients are comfortable with rather than dictating treatment. Miranti adds that patients who trust and like their clinician get better clinical outcomes and follow the plan they helped build. Lay the foundation in that first encounter, and growth, success, and referrals follow.
Connecting With Kids and Families
For pediatric visits with parents, grandparents, or the whole family in the room, Neita treats the child like any other patient. She introduces herself directly to the kid, no matter their age, asks their name and how to pronounce it, and asks them directly about their history, how long a spot has been there, whether it itches or hurts. Shy kids get grace; confident six- to eight-year-olds often give a full history.
Miranti looks for a small connection, a sports team on a shirt, a Marvel character, a football position, to get a nervous child out of their shell. Throughout, the goal is mutual, shared decision-making with the parents while still treating the child with full respect regardless of age.
The closing message applies whether you've been in practice five minutes or fifty years: take time to make connections with patients at every age and every stage of their journey, even the grouchy ones, even the crying ones. That, both hosts agree, is what being a patient's advocate is all about.