How Your Smile Can Put You in Trouble in Clinic

Something happened a while back in clinic that has stayed with me. I have been meaning to share it for a while now, and I think today’s the day.

It was a regular busy day. Two patients came in, one after the other, and I had two completely different experiences both of which taught me something important about communication and emotional intelligence in clinical practice.

The first patient walked in, clearly in pain. I greeted her like I normally do—with a smile. But mid-session, she looked at me and asked, “Why are you smiling? I’m in pain and you’re there smiling. What’s so funny?”

She was visibly upset. I quickly apologised and did my best to calm the situation before it escalated. But it caught me off guard. I left that session feeling deflated, carrying the weight of that moment into my next consultation.

Now, here’s where it gets interesting.

The next patient came in and noticed something different. She said, “Where is your smile? I saw you last time, and you had such a beautiful smile. I was looking forward to seeing it again.” Apparently, I had seen her before, and she remembered how I made her feel just by smiling.

Same smile! two different patients! and two totally different responses! One felt seen and comforted by it, the other felt offended. And that’s the point I always try to emphasise when mentoring clinicians: Clinical communication is never one-size-fits-all.

It is easy to give advice like “just be yourself” or “always be warm and friendly,” but the reality is more nuanced than that. Not every patient wants the same energy from you. Some come in angry, some happy, some anxious, some indifferent. Your job as a clinician is to read the room every single time.

The real skill is emotional agility.

It is not about pretending. It is about mirroring the patient's emotional tone, especially in MSK and one-on-one care settings. That patient who was offended by my smile did not have an issue with me personally. The issue was that I had not picked up on her mood quickly enough. I failed to adjust. That was on me.

On the flip side, the next patient missed that same smile. She remembered it. She valued it. It made her feel comfortable the last time. That just goes to show your ability to adapt is what makes you an excellent clinician.

Here’s the lesson:
If a patient comes in happy, match that energy.
If they are quiet or slow, bring your tone down.
If they are bubbly, engage with it.
If they are frustrated, take a step back and listen.

And lastly, it must be said: take time to cool off whenever you have a difficult consult. No need carrying that same energy to the next consultation because there is a tendency to transfer emotions

Back to the lesson. We call this the mirror technique. It is a simple yet powerful approach that helps avoid misunderstandings and builds trust quickly. And if you are preparing for an NHS interview, especially for MSK roles, this is gold. When they ask how you deal with difficult patients, talk about this. Talk about your ability to read non-verbal cues, to mirror the patient’s emotional state, and adapt your tone and approach accordingly. That is the kind of clinical maturity they are looking for.

And if you are struggling to land an interview or just tired of getting rejections after applying, I run a mentorship programme where we deal with all these things, interview technique, supporting information, and real clinical examples like this one.

You do not even have to join the full mentorship if you are not ready. You can grab one of my e-books:

• “Shortlisted: Ultimate Guide To Writing A Supporting Information” – A Practical Guide For NHS Job Applications.

• “CV & Cover Letter Made Simple” – especially if you are applying internationally.

• “MSK Clinical Assessment Blueprints” – perfect for those working in MSK clinics and want to sharpen their subjective assessments and red flag screening.

These resources are designed to make you better clinically and professionally. And can all be found here : Store Home - adebola badiru on Selar

Anyway, I just thought to share that story today. It reminded me that the little things we do, like a smile, can have big effects but only when they land the right way. The real skill is knowing when to smile.

Have a lovely day, and as always keep learning, keep growing.