The Patient’s Worst Fear or, questions that take my hand off the doorknob

In medicine physicians often talk about the patient concerns that come up in the moment we are leaving the room. The “oh by the ways”. The comments that come when the doctor has a hand on the doorknob, one foot out the door. Mostly, these are simple, quick requests (work notes, PE excuses and the ilk). But every now and then they are real humdingers.  Yesterday I had one of those moments, and it got me thinking about what I do and how I do it.

Work has been busy lately. The clinic is full of kids with colds, earaches, and influenza; lots and lots of sick kids. The volume of patients is pushing us to be very time efficient, very focused in our approaches to care. Yesterday in the afternoon a teenaged patient came in with several separate non-urgent concerns. We worked through the history, examination and plan for each of these and I needed to move on to the next patient. Make that patients – four were waiting. So when, as I was touching the door handle, their parent asked her if they wanted to tell me about another issue I admit that I inwardly groaned. Outwardly I explained that I had four people waiting and that maybe we could schedule an appointment next week to discuss this concern. But something was bugging me about the atmosphere in the room. Some alarm beeping in my head made me stop, take a deep breath and ask if I could on second thought, hear what was worrying them.

It was one of those moments that highlights how much of medicine is an art. Much of being a good doctor involves having an emotional intelligence that helps us know when to take our hand off of the door. I wish that I had never actually reached the door. I wish that I had responded earlier in that visit to the little alarm in my head.

There is lots to read on the internet now about how a patient can prepare for a visit with their doctor. Ideas about advocating for one’s healthcare. Making lists of questions to ask. All often form good advice. I would add this piece of advice for patient interaction with physicians: state your fears upfront. Tell the doctor what your biggest worry is. Tell them what keeps you up at night. Doing so is important for several reasons. We can often calm your worries better if we know what to approach. You are your child’s expert and have input that is valuable to us. We may though, need to schedule another appointment. And, of course if the doctor manages to get out the door without knowing that last “oh by the way” humdinger we may have failed to treat the one medical symptom that actually would have scared us and kept us up at night.

My teen patient will be fine now but they needed that last moment of my attention. Without it they would be very ill today. The other four patients? They waited and understood that I was late because I had been helping another child. They understood that I not been off doing my nails or reading a novel. That is for today.

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For more insight into the approach physicians take to office visits read this excellent outline by BrianVartabedian. It absolutely sums up how I also try to structure a patient visit.

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