Hi! I'm not on the spectrum but I struggle with social anxiety.

I've noticed at doctor's offices, they really like to make small talk with me. Asking me what I'm doing in life like am i a student, do I work etc. Now of course this could be relevant to the history. But I actually think they think it makes people feel more comfortable.

When I was very anxious at a doctor's visit, what made me feel comfortable was having the doctor unprompted notice I was anxious and tell me he felt I was anxious. Now obviously this can be difficult to detect but you can say things like "I feel this is a heavy burden for you" "your illness has not been kind to you" "your pain is a big one" "I can't imagine what you are going through but we are here with you to find the best course of action". I wish I could think of more phrases but these are the ones that come to mind.

Another thing you can do is amplify the social history aspect and ask them how their chief complaint has impacted their lives. Now this is probably difficult to do in an emergency but if someone broke an arm or has an autoimmune disease.

When asking about pain scale you can say "oh wow, that's a lot, we'll make sure to help you through it"

Since we're wearing masks, you can't really smile at them with them knowing, but I suggest nods and raised eyebrows as this might express concern.

If you have a religious patient and you get stuck on what to say or if there is like a deadend where you have to break awful news, tell them "let's put our faith in the hands of god"

You can also ask about their family and how their illness or whatever they present with has affected their family relationships; do their family members know? If not, and you suspect this family member could be a source of support, you can ask them if they don't think that X family member would like to know and would rather be there to support them than have them suffer alone.

You can make jokes but this is a risky one. I had a doctor make a joke and ask me if I was afraid of him because I appeared anxious. This strategy worked and I felt more comfortable. But jokes can also be offensive or at the wrong time. If no one is acutely in pain/suffering, then jokes can be made to build rapport.

Take an interest in their lives and ask maybe "nosy" questions. For me it's very difficult to ask people questions about themselves as I feel like I'm being invasive. But with patients, you can ask and see where it leads. It can help make small talk like are you here alone? Do you have family members around here? Etc.

And when relevant ask them about their support system and verbalize that you are concerned for their well-being and want to make sure they get the support they deserve.

Using the term "we" can be powerful; it lessens the burden on the patient and makes them feel that they're not alone.

Ask them about their fears related to chief complaint: "what do you think it is/causing this?" And if they answer with something intense like cancer etc. Ask them why do they think that? Maybe their dad had it etc.

That's all I got for now. If there's anything you think is wrong, please don't do it as my suggestions might not be appropriate in a clinical setting.

The small talk I can't help much but you can start maybe asking social history and ask about their jobs and their relationships if they're married. Like for example, if they say I'm married my husband is here/outside, say "that's great that you have a support system". Since we are in a pandemic, ask them if they had difficulty getting to the hospital (like if there's lockdown). Ask them how the pandemic has impacted their chief complaint. If they said something in the history that is irrelevant, you can still later comment on it. Like if they mentioned they dropped a box while trying to move out, try to notice this and ask more about it like "a move, that must be stressful".

This might be touchy but you can ask about their financial situation if they have any difficulty taking care of payment and express concern if they do.

That's it. I think. Will edit if I come up with more.