Doctor Wandless, Let’s Talk About Your Tone

Tone. It’s one of those words that only seems to come up when someone’s pissed off. No one ever says, “Loved your tone, doc.” When you hear it in a complaint, you know something went wrong — or at least felt wrong.

And here’s the thing: it’s rarely just about how you said something. It’s usually what you said — or that you dared to say it at all. “Tone” is the polite code for emotional friction. It’s the word people reach for when they don’t have the tools to unpick why something hit wrong. In medicine, that matters more than we often realise.

Tone and Transactional Analysis

If you’re into psychological models (and I am), tone fits neatly into the framework of transactional analysis — the parent-adult-child model.

• Parent: instructive, sometimes condescending.

• Adult: balanced, ideal.

• Child: reactive, vulnerable, or defiant.

How we speak — our tone — reflects which role we’re taking up. And under stress, most of us default to wherever we feel safest.

That’s what I learned during Sim Ward back in med school: six problem patients, one caustic consultant, one exhausted nurse. It wasn’t about shining. It was about survival. I defaulted to “blunt adult” with a shade of “bratty child.” It wasn’t pretty.

These power dynamics matter. Chullieva (2025) notes that tone, non-verbal cues, and emotional context fundamentally shape whether medical conversations succeed or spiral. Your tone cues the other person’s role — whether you want them to push back, retreat, or engage.

When Tone Becomes the Problem

Let’s not sugar-coat it: I’ve had tone complaints. Not because I was rude. But because I said something someone didn’t want to hear.

“No, you don’t need another scan.”

“No, that’s not how this works.”

“No, I don’t think that prescription is safe.”

Sometimes the tone is fine. It’s the no that isn’t. And when expectations aren’t met, tone becomes the scapegoat.

This aligns with Kee et al. (2018), who reviewed patient complaints and found that emotional perception — not factual content — was the strongest predictor of dissatisfaction. In other words, it’s not just what you say; it’s how it lands.

Continuity and Context

Tone problems often arise in fragmented systems. When patients don’t know you, they don’t know how you speak — or that your directness isn’t disrespect, just… efficiency.

I’ve inherited patient lists where the previous doctor said yes to everything. I walk in with guidelines, lifestyle advice, and a dash of optimism, and get daggers. Because I’m not matching the script they were used to.

Williams et al. (1998) found that continuity and trust build tolerance for direct communication. Patients were more forgiving of sharpness or firmness if they had an existing relationship — and more critical when tone came from a stranger.

Owning Your Voice

I’ve worked on it. I try to summarise, check understanding, read the room. But I’m also someone who speaks enthusiastically, sometimes a little too fast, sometimes a little too frank. And while I won’t apologise for having a voice, I’m learning to tune it.

Tone is a diagnostic tool — for both parties. Lipp et al. (2016) show that empathetic tone alone can reduce complaint rates and improve patient trust, even when outcomes aren’t ideal. You don’t have to be theatrical — but you do need to be aware.

Still, complaints happen. People mishear, misread, or misplace emotion. Swaminath (2007) argues that complaints about tone are often proxy expressions of fear, grief, or unmet need — especially in emotionally charged contexts.

And yeah, when your surname is Wandless, people remember it. I’ve had complaints where all I did was prescribe fluids — but it wasn’t the action. It was how the moment felt.

Final Thoughts

Tone isn’t a fixed trait. It’s dynamic. Contextual. Hard to perfect.

But knowing your defaults — and when to flex — is a clinical skill, not a personality quirk. The best communicators aren’t robotic or charming. They’re aware.

So when someone says they didn’t like your tone? Don’t just dismiss it. Ask:

Was it the tone, or the truth that hurt?

Either way — it’s worth learning from.