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Many physicians are not born communicators and most have not had formal teaching and training to hone their communication skills. Recognizing these deficiencies, the American Academy of Pediatrics has provided valuable guidance and made specific recommendations for the development and teaching of communication skills,²⁰⁶ as have others.^{207, 208}

Simple language, an adequate allocation of time, care, and sensitivity are keys to successful genetic counseling. Technical jargon, used with distressing frequency,²⁰⁹ is avoided only through conscious effort. How an issue requiring a decision is framed²¹⁰ and the nature of the language used²¹¹ may influence the patient's choice.²¹² Counseling is facilitated when three key questions are asked: “Why did you come?” “What exactly do you hope to learn?” and “Have I answered all your questions and concerns?”

Although the explanation of exact statistical risks is important, patients often pay more attention to the actual burden or severity of the disease in question. How risks are explained and expressed is a skill to be mastered. Key to the exposition is the patient's educational level, cultural background, and the requirement of an interpreter (who may even bedevil a superb counselor). The use of numeric probabililties, relative risk, risk reduction or simple numbers of chance (1 in 100) or words (almost never, negligible, sometimes, more often than not)²¹³ are choices a counselor must make. Clearly, the simpler the better and the more likely the information will be understood. Patients' perceptions of risk not infrequently differ markedly from those of the counselor, a realization that should elicit no comment. An essential ingredient of the counseling process is time. The busy practitioner can hardly expect to offer genetic counseling during a brief consultation. Distress and misunderstanding are invariable sequelae of such hastily delivered counseling.