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After asking patients questions about their goals and preferences, it is very helpful to paraphrase or re-phrase what they have said.

Paraphrasing requires practice! When done well, it...  

•    builds rapport.
•    demonstrates to the patient that you are listening and have heard them.
•    allows you to incorporate information you have gathered from things they have said throughout the conversation; their facial expressions; body language; tone of voice; and factual information from their history and medical record.
•    gives the person an opportunity to hear their own preferences and desires restated which can help them gain clarity about what is really important to them.
•    gives them an opportunity to hear their own priorities spoken out loud.
•    gives them an opportunity to correct you in case you have misheard or misunderstood.

· If they correct you and you are not defensive, it contributes to building rapport as they see your priority is to understand them.
· If they correct you, they have a chance to re-consider what they had meant by what they had said and further explore their thoughts, feelings, and desires.

•    allows you to be efficient and influence the length and focus of the conversation.
•    allows you to summarize and synthesize various things the person has said about their preferences in order to move towards decision making.

Each time the person answers a question about reproductive goals or a question about contraceptive preferences, listen carefully and then re-phrase what they said.

Pay attention to words, facial expressions, body language, and tone of voice.

•    Paraphrasing is not simply repeating what the patient said. Re-phrase using different words and capture the essence of what the patient meant.
•    In your paraphrase, incorporate both verbal and non-verbal information.  Part of your paraphrase is your non-verbal communication.
•    You can be more succinct (or more detailed) in what you say when you paraphrase then they were.
•    If you aren’t clear on a point, use paraphrasing to clarify.
•    You can paraphrase so that you reflect back to them a summary of what they said by putting together content from various things they have discussed at different points during the conversation.
•    Check at the end of each re-phrase with something like, “do I have that right?”

•    Phrase 1: “So I hear you saying... [one of the most important things to you about your birth control is that it doesn’t cause you to gain weight]....  Do I have that right?”
•    Phrase 2: “It sounds like... [being able to get pregnant when you are ready is your top priority].  Is that what you mean?”
•    Phrase 3: “So, you feel pretty strongly about… [not getting pregnant before you finish school].”
•    Phrase 4: “Many of my patients say they… [have side effects from hormones].  Is that what you mean?”

(This last phrase is not really a re-phrase.  This phrase helps when you have a guess about what you think they mean but they have not actually said it.)

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