Avoiding the dreaded “door knob conversation”

We are all way too busy – so we prioritize. We put the most important things first and relegate the less important to any time we have left. We assume that our patients do the same. But, as my kids’ fifth grade teacher wisely warned, “When you assume, you make an ass out of u and me.”

When we ask our patients what brings them in to our office, they give us an answer. But often, their answer doesn’t reflect the real reason they came in. Maybe it’s the most recent issue that occurred, or perhaps it reflects what someone in the waiting room was discussing. We are fooled into believing that this is what our patient wants us to evaluate, so we spend the entire visit questioning, examining, and explaining just what to do about it. We think we’ve done a good job and begin to leave the room. And then comes the “door knob conversation.” Just as we place our hand on the door knob to leave, our patient says, “Doctor, there’s something else that’s been bothering me.” We ask ourselves why they didn’t tell us before we spent all of our time on what we thought was the real and only reason they came in.

The answer is that we didn’t ask.

To avoid this situation, try using the technique of scanning. After eliciting the reason for the visit, stop and ask, “Is there anything else you would like to discuss today?” Keep scanning until your patients exhaust their list. Then, powered by a more complete understanding of all of the issues, you can do what you do well – prioritize – and negotiate an agenda that will fit in the time available.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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