The traditional way medical students were once taught to take a medical history often turned into a barrage of close-ended questions that could actually limit doctors’ understanding of patients’ experience of illness.
I’m happy to report that medical school has evolved. Students are learning early to listen better, to ask more open-ended questions and to invite patients to share more information.
We know that patients put a lot of thought into how they are going to explain their problems to their physicians. They might be rehearsing what they’re going to say on the way to the clinic or hospital and again just before they meet with their doctors.
When I teach medical students and residents, I remind them that the old adage that the diagnosis is in the history really means that often the patient will tell us the diagnosis but we have to listen.
After making the patient feel at ease, I encourage my students to let a patient talk about their symptoms without interruption. Studies have shown that most doctors interrupt patients within two minutes, and when this happens, they lose their train of thought and crucial information is missed.
By taking time to listen first, we gain more than launching in the typical medical inquisition. Students are now taught to ask more open-ended questions that invite more elaboration from the patient as opposed to the yes or no responses to close-ended questions.
Medical students throughout Canada are taught to attend to more than the physical symptoms of illness. They learn the acronym, FIFE. This reminds them to ask patients about their feelings (fears and other feelings related to the experience of their illness), ideas (the patients’ own ideas about their condition), function (how the illness affects their daily lives) and expectations (what they expect from the doctor and from their condition).
Though old habits are difficult to change, I’m optimistic that doctors will continue to improve the way they communicate and relate to their patients. You could help.
Do you have any comments or suggestions on how patients and doctors communicate? Please share your ideas here.