hilst reflecting on my placement experiences I realised I had used the Linear model to communicate with a patient who had suffered a stroke, resulting in very limited speech, I felt guilty because I could not understand her. I began to dread answering her buzzer calls. How I would feel if the situation was reversed? Very frustrated with the words in my head not able to make myself understood. Instead of panicking I took time to really listen to the sounds she made, repeated what I thought she had said. If I was wrong she would use her good hand to demonstrate. By nodding and shaking her head eventually we would understand each other, I learned a great deal about good effective communication from her. Next time I am faced with a similar situation I will remember communication is more than just the spoken word.

Not all patients are agreeable and likeable and some may be particularly surly or ungrateful. It can be very difficult to work with such people, but as professionals we need to remember equality of care vital to our Code of Conduct as professionals NMC (2002), and also to the therapeutic relationship. It is easy to develop a relationship when faced with a likeable, co-operative person. What happens when we are faced with a difficult and un-cooperative patient, how can our therapeutic relationship develop, what strategies can we adopt to help it? Cava (1996) suggests a difficult person is one whose behaviour causes problems for you, or others. When coping with a difficult patient it is the behaviour we need to deal with. Behaviour revolves around communication; it is not about liking or disliking a patient but identifying behaviour and dealing with it. Communication is a two-way procedure, if we reac