Objective: To investigate whether and how orthopaedic surgeons tailor communication during medical consultations based on perceived patient characteristics. Methods: Seven orthopaedic surgeons were repeatedly interviewed following an approach based on ecological momentary assessment. Qualitative content analysis was used to analyse the eighty short interviews. The association between patient characteristics and tailoring approaches was explored in a correspondence analysis of the counted codes. Results: Surgeons estimate patients’ competence (illness management and communication abilities), autonomy, and interpersonal behaviour. They report tailoring communication in two-thirds of the consultations. The surgeons’ perception was associated with the employment of specific approaches to communication: (1) high patient competence with extensive information provision or no changes in communication, (2) less autonomy and less competence with reassurance and direction, (3) high autonomy with discussions about pace and expectations, and (4) high sociability with communication about personal circumstances and wishes. Conclusion: The surgeon's perception of a patient influences communication during consultations. Future research should address whether these intuitively employed approaches are appropriate, effective, and generalizable to other medical specialists. Practice implications: Tailoring physician-patient communication can improve its quality. The novel approaches identified in this study can be used to formulate and test formal guidelines for tailored communication.