ABSTRACT
Short-cuts are techniques for shortening decision making, based on assumptions formed from knowledge or past experience. They always involve an element of risk-taking but are often a valid, reliable and necessary way to make decisions based on limited information. Interpersonal skills are usually thought of as a taken-for-granted sub-set of communication skills, within which, as experience accrues, is an increasingly influential perceptiveness about people in general. Interpersonal skills are analytically singular and are easy to identify for feedback. During training the focus is on levels of interpersonal skill appropriate for certification and subsequently, in the Dreyfus sense, on competent consulting. The achievement of concordance requires clinical acumen and highly developed interpersonal behaviours. Concordance increases the challenge for both doctor and patient, opening up the possibility of disagreement and conflict. Evidence-based medicine attempts to remove idiosyncratic clinical decisions but may conflict with patient-centred medicine.
