The competence of communication is perhaps the most common and universal of the medical and health-related service (Henry et al., Reference Henry, Holmboe and Frankel2013). It is a given that a good relationship between the physician and his/her patient leads to a significant improvement in their satisfaction, and consequently to a better therapeutic adherence, among other things. Furthermore, we are currently living in a world in which communication systems (mobile phones, social networks, video conferences, etc.) are of the utmost importance. For this and other reasons, it seems logical to think that integrating communication skills in medical schools would be in accordance with that development (Ferreira Padilla et al., Reference Ferreira Padilla, Ferrández Antón and Baleriola Júlvez2014).

During the first day of clinical clerkships (in Spain it is usually in the third or fourth year into the undergraduate medical education), the professor of medicine assigns each student one or various patients. He/she takes into account the limitations of his/her inexperienced students when it comes to the writing up of a patient's medical history.

The professor heads into the first patient's room followed by his/her students, all of them with their white coats and medical equipment (stethoscope, reflex hammer, oximeter, etc.) and with their pens ready to write everything so as not to miss a single detail. In this context, it is easy to understand why a patient may think that their privacy is being violated. Also, the patient could even think that their ailment is serious considering the number of doctors that come into the room at once.

The student revises the patient's disease mentally; eager to show he/she knows the right moves to face up to the disease. It is in that moment when the student could fall victim to his/her own inexperience because he/she thinks of the illness instead of the patient although probably, at the Faculty of Medicine, all of them were warned that “there are no diseases but ill people.” The professor and his/her students analyze CT scans, MRI, results of blood tests, etc., but we must not forget that we treat people with a family waiting for our words and with a different personal history.

After the due introductions the student attempts the first contact with a patient for the first time during his/her clinical clerkships. Unknowingly, an atmosphere of fear and mistrust is created at the same time as one of hope. The student, under the watchful eye of the professor (and the fellow students) feels that he/she doesn't know how to establish a relationship with the patient or how and what to ask them. The student's medical knowledge, still in need of improving, drives him/her to a state of nervousness because of an unknown and new situation never lived before; a situation for which, perhaps, was not prepared for in the University yet.

The student is worried about looking the fool in the eyes of his/her colleagues, professor and patient in what is his/her first ever medical history taking. “This is the moment to show and put to practice everything I have studied and learnt from the books.” The student cheerfully thinks, he/she knows the theory but finds it difficult to put it into practice. As a result of this, tries to remember everything that might have been taught in subjects like “semiology,” “psychology” or in the best of cases in subjects like “patient-centered communication.”

The student, in an attempt to demonstrate what have been studied, may make the mistake of using too technical words which, probably, only the professor or his/her colleagues knows. In this case, the key part of the encounter, the patient, would be ignored because the student may not have been worried about adapting to the cultural and intellectual level of the patient.

On the other hand, the patient senses the student's fear but at the same time also detects the young pupil's eagerness to establish a good student-patient relationship that will allow him/her to elaborate a good and detailed medical history taking. Nevertheless the patient's fear is different to the student's as what he/she fears is his/her illness and possible death. In this rollercoaster of emotions, it's the patient who usually concludes with a half-smile, saying something like “don't worry kid, we all have to learn and there's a first time for everything.” This message calms not only the student but also his/her colleagues and becomes a life lesson from someone with experience that reduces the tension of the first student-patient encounter and that ultimately helps create a warm and trusting ambience.

It should be pointed out that in Spain, a student's medical practice is carried out in university hospitals, so the patient is aware that he/she will be seen by medical student and resident alike. Obviously, not every patient has the same level of understanding, patience, tolerance, and collaboration. Therefore, it would be interesting that the professor invites their students to assess the personal situation of their patients.

It seems easy to understand that a student-patient encounter will not take place the same way with a patient who is in a severe situation that with a patient admitted for the first time or who may have a disease of minor relevance clinic. Hence arises a new reflection: it is important patients feel that the doctor or the student is interested in the person who they are; a person who is suffering in that moment. Patient satisfaction is related to the following insight: “they have listened to me as a person.” So in this context, might be appropriate to teach our students that are so important the available scientific arsenal to confront the disease of the patient, as the ability to make the encounter takes place in an environment that allows communication to flow.

Nonetheless regardless of the type of patient the logical thing would be that (1) the adjustment comes from the doctors or students, not from the patient; (2) that the student understands the clinical encounter in its multiple possibilities, and (3) that he/she develops his/her social skills. To guarantee an appropriate relationship with the patient, this competence should be integrated from the undergraduate medical education and should then be reinforced during the next levels of formation (Ferreira Padilla et al., Reference Ferreira Padilla, Ferrández Antón and Baleriola Júlvez2014).

There is no doubt that the learning of a subject like communication skills improves healthcare results and the quality of the assistance (Henry et al., Reference Henry, Holmboe and Frankel2013). Fortunately, traditional education methods have evolved in the last few decades, bringing about a new conception of medical communication that is clearly related with the importance of an early teaching communication skills subjects (Ferreira Padilla et al., Reference Ferreira Padilla, Ferrández Antón and Baleriola Júlvez2014).

In conclusion, based on the clinical experience of the first meeting between the student and the patient, would be interesting to integrate competence in communication in the curriculum of the student. Communication skills training is essential for staff working in cancer services as Jenkins et al. (Reference Jenkins, Alberry and Daniel2010) reported. However, this competence is not only essential for the oncologists or professionals that working with palliative care's patient. These are some skills that every health professional must acquire. Ignoring this situation could cause discomfort, anxiety and insecurity both health professionals and patients.

These reflections have been developed based on the experience of the undersigned, two medical students (currently Graduated in Medicine) and a Professor of Family Medicine.