Why I’m Using a “Running Commentary” with Every Patient

READ TIME – 2 MINUTES

Hey guys,

I want to share something small that’s making a big difference in my practice: running commentary.

I picked this up from another podiatrist, and once I tried it, I realized how much we don’t say out loud during exams.

Here’s what I mean.

Instead of examining quietly and then explaining at the end, I now narrate what I’m seeing and feeling as I go:

• “I’m pressing here—this is where plantar fasciitis usually hurts.”
• “Your heel shifts outward here, which tells me your midfoot is less stable.”
• “This bump is an exostosis. If it doesn’t hurt, we leave it alone.”

I’m not trying to sound smarter. I’m trying to make patients feel included and calm.

Why this works

Patients are always wondering:

• What is he looking at on the ultrasound?
• Why is he pushing there?
• Is this normal?

When you explain in real time:

• Anxiety drops
• Trust goes up
• Your scribe understands more
• Treatment recommendations feel logical—not salesy

I’ve also started explaining X-rays the same way:

• “This angle shows bunion severity.”
• “These bones sit closer together—totally common.”
• “This explains why orthotics help here.”

It’s simple language. No jargon. Just clarity.

Ironically, the more transparent I am, the less pushback I get—especially on bigger treatment plans.

If you’ve ever felt like patients weren’t fully buying in, try this. It’s a subtle shift, but it changes the room.

Key Takeaways

• Silence creates uncertainty
• Narrating exams builds trust
• Clarity improves case acceptance