For medical students, asking patients if they have a fever or chest pain easily rolls off the tongue. In comparison, some students feel clammy hands, knotted stomachs, and tongue-tied when asking a patient about their erectile dysfunction or sexual practices. While each specialty requires difficult conversations, urologists regularly discuss socially taboo and personal topics with patients. To do this successfully, they build trust with patients through productive, honest, and inclusive conversations. We gathered advice from practicing urologists about how they ensure patients feel supported and secure during each visit. The goal of this article is to disseminate their advice among medical students to help them feel more confident during these conversations and improve their patient care.

An anonymous survey was sent to faculty and residents within the Department of Urology at a large academic institution. A survey link was posted on the social media platform X, which yielded additional responses from the urologic community. The survey included multiple-choice demographic questions, open-ended questions, and free space for physicians to share any additional pieces of advice. Respondents included residents and attendings early in their training (55%), physicians who have practiced for 10 to 15 years (18%), and 15 to 20 years (18%). Respondents represented both general urology and subspecialties.

In response to “What did you learn to do or not to do when you were early in your career to build trusting relationships with patients?,” urologists repeatedly emphasized the importance of listening and providing space for silence. For example, one physician said, “Take time and listen to your patients. Even though you may know what they need for treatment, they want to be heard and want to have a say in their care.” Medical students often worry about not having the right answer for patients, but one resident pointed out that listening can be more important than speaking when building a trusting relationship. They explained, “Patients don’t always care what you say, but they care that they’re heard” and “Trust takes time to build.” Listening can involve addressing and expressing empathy to unsaid subtle cues. When this was done, patients felt they had experienced a higher quality visit with their physician.¹

Urologists shared that honesty went a long way in building trust with patients. One urologist acknowledged that it can be difficult to find the balance between honesty and oversharing, stating, “Being honest and upfront, especially in uncomfortable situations and related to complications, is not easy. Besides doing everything you can to prepare a patient, being honest is always the best policy.” When it comes to difficult conversations about a diagnosis, one resident said, “I think honesty is a quick way to take down any barriers, and people want to hear the truth.” Whether the conversation concerns a more sensitive topic, complication, or care plan, honesty about the important information (without medical jargon) will help lay a foundation of trust and help patients feel comfortable.

Finally, respondents said it is easier to have uncomfortable conversations when they show humility, authenticity, and patience. A few attendings shared their approach to create good first impressions with new patients. “Always start with a smile, introduce yourself, and bring some levity to the visit. Patients like it when it is not overly stuffy or formal.” This is especially important when treating patients with backgrounds that differ from their own.

When asked about working with patients from historically marginalized groups, one respondent mentioned that they “tend to allow more space and time for those of groups that have been historically marginalized so they feel more comfortable.” For example, a urologist expressed the importance of humility and patience when discussing prostate cancer with patients who are Black, stating, “I make it a point to acknowledge possible distrust in the healthcare system and try to see if there is something I can address.” Likewise, one physician mentioned, “[I] always sit down when I talk to patients when I can and [I] never assume.” Additionally, physicians are seeing an increasing number of patients from the transgender community. In a study describing the perspectives of transgender and nonbinary patients seeking urologic care, patients cited a lack of cultural competence as a hindrance to their care.² Acknowledging an incorrectly used pronoun shows humility and a desire to improve, both of which foster shared decision-making. While these strategies may take extra time, they can be the difference in establishing a supportive relationship with the patient.

Survey respondents shared parting advice emphasizing that it takes time to build up and practice these skills. As one urologist said, “It’s hard. I remember as a medical student, it was hard. It is hard for patients too, and they are often shy. You should always let them know we talk about this stuff all the time and just talk about things as if it was a matter of fact.” Confidence from both sides facilitates a connection between the provider and the patient.

As medical students, particularly those interested in urology, sensitive conversations will become part of our everyday practice. Facilitating these conversations efficiently is a skill that we will build upon throughout our careers. We hope this advice may be useful throughout your journey, and we thank our survey participants for sharing their experiences.