I agree, that the small talk is a waste of time in the sense that engaging in this form of chatter does NOT generate any points for you. That's your sole purpose, is to do whatever you need to do to generate points. As mentioned, knock before you enter, extend your hand, introduce yourself, drape the pt, ask for permission before starting the physical, counsel every pt re smoking cessation/safe sex/alcohol cessation, offer social work, wrap up with some diagnostic possibilities, etc.