A Doctor's First Words to a Patient
“Interesting belt — where did you
get that?”
“I see you are from Youngstown.
The key question is, are you a Steelers fan or a Browns fan?”
Daniel R. Wolpaw, M.D., and Dan
Shapiro, Ph.D. writing a Perspective article titled "The Virtues of
Irrelevance" in the April 3 2014 issue of the New England Journal of
Medicine present these as examples of possible opening remarks by a physician
to a patient who appears with a medical problem. The authors suggest that remarks such as
these serve 4 "key purposes" from the physician's point of view which, in
establishing the doctor-patient relationship provide "ways to establish
the connections that allow us to actually care for the person in front of us."
They explain: "First, they convey
that we see the patient as a unique individual. Given the speed of medical
practice, it is not surprising that patients worry that their individual
concerns will not be heard. Second, these questions reveal that we have had
shared experiences, that despite our training and attire we are not so
different from the patient. Third, they communicate that we are observant and
attending to details, which patients find comforting. And finally, they
indicate that we are open to a conversation with the patient."
I am not going to start out with
a detailed discussion on my part regarding the pros and cons of a physician beginning
the doctor-patient relationship with what might seem as irrelevant
communication. What I want to read is what my visitors to this thread think should
be the opening question by a physician to their patient: "Tell me about
your concerns" or something to that effect or instead to begin with "irrelevance"
..Maurice.
Graphic: Via Google Images from Wall Street Journal by Linzie Hunter and modified by me with Picasa 3.
posted by Maurice Bernstein, M.D. @ 9:29:00 PM
10 comments
10 Comments:
Most often, after an initial greeting, I'm asked, "Why am I here?"
Given that most visits are limited in time, I don't feel like making small talk, so this works for me.
I would prefer to send my complicated medical history ahead to save time, but the offices always say the same thing, that they have nowhere to put it and it will get lost.
So, I supply detailed history and when they give me their forms I write, "See attached".
I have been both complimented and criticized for the same behaviors. Most docs love it that I'm on top of everything, have copies prepared ahead of time for what they need for them to keep, along with a timeline for what happened, when so they get they have entire picture.
The psycho social issues aren't brought up unless there's a reason but won't hesitate to do so, if needed.
Very rarely, if ever, has there been small talk and I go to many doctors.
belinda
Thank you for this ...it is so important that students connect with their patients on may levels in order to provide the best overall care.
Lost my long time MD to obamacare. My 2nd visit to my new MD. He walks in, looks at me and says So how is life treating you? I told him just another day in paridise. he gives me a high five and away we go. It is not only what he said it is how. That connection is so important. Need proof? The nurse took my PB when I entered, 165/85. He comes in, we talk do some stuff, he takes it again 128/80....comfortable shows up in all sorts of ways....don
Belinda, you wrote "Very rarely, if ever, has there been small talk and I go to many doctors." Tell us, would you desire more "small talk" and would this provide you with more confidence and likability in and for your doctors? ..Maurice.
But Lorree, with regard to the "first words" of the medical student, we instruct them to identify themselves and their role in relation to the patient and then to ask the patient to inform the student about the present illness. We don't teach them to begin with commentaries distant from the patient's illness. The question is: have we been teaching wrongly and should we be teaching to start out with conversation similar to neighbors talking over their fence? Is that the best way to start a relationship which can eventually lead to communication regarding the patient's illness? ..Maurice.
Don, I would say that your doctor's opening words would NOT be characterized as irrelevant to your visit itself and thus would not be the same as "interesting belt". And, by the way, performing "high fives" already provides the doctor with information regarding the physical condition of your upper extremity muscles both proximally and distally, the joints and also your state of coordination. And no undressing was necessary for this exam. This act can provide the doctor with more information than simply hearing "just another day in paradise." ..Maurice.
Maurice,
Sometimes you "click"with a doctor just like a personal friend and sometimes they feel like a stranger every time. It doesn't matter to me.
What I care about is a doctor who works as my partner to make recommendations and who works with me to make the right decisions for me. It's the dynamic, medical background, and respect for my autonomy that makes me comfortable. That becomes apparent and when it doesn't work, I don't go back.
Once a relationship is established sometimes we'll chat about our children, or a vacation.
Conversation is a waste of time and sometimes feels patronizing and frankly, I want to talk about my health issues when I get my fifteen minutes.
Finally, I guess I answered the question and it's a big fat NO.
I don't care about the small talk.
belinda
Anonymous
"Now doctors develop more of a relationship with their computers in the room. They do not look at me anymore." I should just participate in an on-line visit"
I do not give up though as I met one doctor who just push away her computer and looked me in the eye, smiled and said, I love your outfit! How is life nowadays for you? How is Cherry? and paused... listening intently before she proceeded to asking "What are we doing for you today?
There are still few of those doctors left in this day and age of technology...Someone who really cares and not worried about that 10 minutes they have to do whatever they need to do....
MM
Anonymous
Doctors have different styles... some are more informal with patients and make small talk, others get down to business right away. Some will be informal with some patients and not with others depending on their sense of what the patient wants and needs. Personally I don't start off with small talk (I'm an NP) but if it's a repeat patient I might bring up something the patient mentioned at the last visit (so how was your trip to Mexico?). They're usually amazed and appreciative that I can remember these details of their lives.
So Chara, your differential "first words" for the visit between a new and a repeat patient seems to me as very appropriate and makes sense to me if the goal is to establish and maintain trust by the patient of the medical provider. ..Maurice.
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