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patient-doctor relationship

Doctors Learning to Listen Better

In medical school, we learn the art of questioning and we are taught that the diagnosis is usually revealed in the history. Students memorize a barrage of hundreds of questions to help them narrow the wide differential diagnosis that they are working out in their heads while they talk . . . and listen.

When I teach medical students and residents in my clinic, I first demonstrate a crucial but oft neglected aspect of taking a proper history. After our patient leaves, I ask them if they noticed what I did.

Sometimes they don’t. It’s that subtle yet it can make a difference.

After greeting patients by name with a handshake (after which I clean my hands with Isagel – we practice that to an art as well), I’ll ask how they have been and what brought them to the clinic (Most of the time, they don’t say the taxi, bus or partner). At this time, I’ll let them talk uninterrupted for at least 2 minutes.

This may seem counterintuitive in a busy medical office especially if we’re running behind schedule. However, this practice can save time, enhance communication and help me make the right diagnosis.

When we plan to see a physician for a medical problem, we will formulate in our minds how that problem presented. It can be quite a detailed story that we rehearse in our minds while we are waiting for the appointment and in the minutes before we actually see the doctor.

When patient-physician interactions were observed, it was found that most physicians interrupted their patients within 2 minutes.

If I interrupt patients before they finish a few sentences, I would have derailed the telling of their story. Crucial details may be missed that may or may not be picked up in the typical medical interrogation, and without enough information, we are more likely to miss the correct diagnosis.

After my patients explain their symptoms in their own way, I’ll ask for those further details we learned so well in medical school.

Of course, not every problem or all patients need as much time to tell their story, but it’s important for the well-being of the patient and the health of the patient-doctor relationship to give that time and to take the time to listen.

Categories
patient-doctor relationship

Rushing to a Diagnosis, Doctors May Listen Less

In medical school, I learned the art of medical questioning. We didn’t realize that to the patient it can feel like an inquisition.

When the “chief complaint” (Yes. That is the medical term for a patient’s main presenting concern.) is pain. We were trained to ask, “When did it start?” “Where does it radiate?” “What makes it better?” “What makes it worse?” “Is it worse with activity?” “Is it worse after eating?” “What kind of pain is it? Sharp or dull? Colicky? Lancinating? Crampy? Squeezing?”

When the pattern of your answers to our patter of questions seems to fit the typical presentation of a clinical syndrome (i.e. gallstones, peptic ulcer disease), our questions become even more focused and specific as our differential diagnosis (the broad range of potential diagnoses) quickly narrows to one specific diagnosis.

The risk of narrowing that differential too quickly is to force the patient’s symptoms into the tight box of the diagnosis we have in mind. That may very well be the wrong one.

Next: How some doctors are learning to slow down and listen.