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.