Simon Smail is a GP, trainer, and occupational health physician in Edinburgh, and medical director of Evergreen Medical & Wellness Clinic. He is on LinkedIN
Koki Kato’s recent BJGP article, “Correct, but not reassuring”, made me reflect on something I do most days in general practice. ¹ His point was that a correct answer is not necessarily a reassuring one. Patients arrive with a story already in place, and our explanation must make sense within that story if it is to resolve their concerns.
A patient sits down, rolls up their sleeve and points to a brown, warty lesion they are worried might be a skin cancer. It has all the features of a seborrhoeic keratosis. I examine it and explain why it is benign and not the cancer they feared. I watch as their shoulders drop in relief.
For me that moment is one of the genuine pleasures of general practice. But it is easy to underestimate what has happened. The patient came with a lesion, a fear and a story. The diagnosis addresses the lesion; reassurance addresses the other two by helping the patient build a new understanding of what is happening.
If reassurance is such an important part of general practice, why does it have so little place in how we teach the consultation?
If reassurance is such an important part of general practice, why does it have so little place in how we teach the consultation?
Roger Neighbour’s five checkpoints — connecting, summarising, handing over, safety-netting and housekeeping — have shaped how generations of GPs think about consultations.² Reassurance is nowhere among them. A sixth checkpoint may not fit neatly on Neighbour’s hand, but reassurance is too important to remain hidden between the fingers. We tend to assume it will be covered naturally once the diagnosis has been made and the plan agreed. Yet reassurance requires knowledge, judgement and skill. It deserves to be taught as deliberately as the other tasks of the consultation.
That does not mean reassurance is a single event near the end. It should run through the whole encounter.
During connecting, we need to understand not only the symptom, but what the patient thinks it might mean and what has shaped that concern. During summarising, we should show that we have understood both the clinical problem and the worry attached to it. During handing over, we need to offer a positive explanation: what we think is happening, why we think that, and what makes the feared diagnosis less likely. Establishing that the patient accepts the plan is not the same as knowing their concern has been answered.
Reassurance also needs to survive safety-netting. Poorly handled, “I don’t think this is serious” can quickly become “but seek urgent help if…” followed by a list of several frightening sounding possibilities. We need to distinguish clearly between what is likely and what is merely possible, so that safety-netting does not undermine the reassurance built during the consultation.
This is why reassurance should be threaded throughout the consultation and then checked explicitly near its end. I would place a sixth checkpoint — reassuring — after safety-netting and before housekeeping.
Evidence from primary care suggests that reassurance which builds understanding is more consistently associated with better outcomes than warmth and encouragement alone.³ Teaching reassurance should therefore include how to explain clearly, calibrate certainty honestly and check that the explanation addresses the specific concern that brought the patient to see us.
But using reassurance carefully does not mean reserving it for consultations in which nothing serious is wrong.
It should also include knowing when reassurance may be unhelpful. In health anxiety, repeated reassurance-seeking can become part of a cycle that maintains rather than resolves concern.⁴ Recognising when reassurance is building understanding, and when it is merely providing short-lived relief, is part of the same clinical skill.
But using reassurance carefully does not mean reserving it for consultations in which nothing serious is wrong. It has a place in every consultation, including those in which we deliver bad news.
“You do have a skin cancer, but I am pleased to tell you it is a basal cell carcinoma, not a melanoma, and we can treat it.”
Even when the diagnosis is truly bleak, there is still something reassurance can offer. I cannot take the diagnosis away, but I can promise that we will continue to treat the patient’s pain and that we will not stop caring for them. Reassurance here becomes something even more important: hope.
Precisely because reassurance can mean more than telling a patient that nothing serious is wrong, it deserves to be recognised as a clinical skill and consciously checked within the consultation.
Reassuring: have I addressed the patient’s concern in a way that makes sense within the story they brought with them?
References
1. Kato K. Correct, but not reassuring. Br J Gen Pract. 2026;76(769):363. doi:10.3399/bjgp26X746193.
2. Neighbour R. The Inner Consultation. Lancaster: MTP Press; 1987.
3. Pincus T, Holt N, Vogel S, Underwood M, Savage R, Walsh DA, et al. Cognitive and affective reassurance and patient outcomes in primary care: a systematic review. Pain. 2013;154(11):2407–2416. doi:10.1016/j.pain.2013.07.019.
4. Halldorsson B, Salkovskis PM. Why do people with OCD and health anxiety seek reassurance excessively? An investigation of differences and similarities in function. Cognit Ther Res. 2017;41:619–631. doi:10.1007/s10608-016-9826-5.
Featured photo by National Cancer Institute on Unsplash
