The most critical aspects of a patient encounter are the first and last minutes. Consider these encounters like plays or novels with an introduction, middle, and end. The introduction and conclusion have the greatest impact on patients and are the parts they are most likely to remember. Thus controlling and managing the first and last parts of the patient visit will allow you to connect with patients and create a positive experience.
Imagine two scenarios:
The doctor enters the room without introducing him self or herself, sits down and looks at the computer screen, interrupts the patient after 15 seconds, never looks at the patient, and then writes a prescription and leaves. The doctor enters the room, looks the patient in the eye while shaking hands and does the same for all the family members present, including children. The doctor then asks about the latest vacation, prompted by a note in the chart. After taking a history, the doctor examines the patient, even though the lab values have given the diagnosis and make an exam moot. Then the doctor sits down, faces the patient directly, and interacts with both the patient and family when discussing the diagnosis and treatment plan, allowing time for questions. The staff provides a written treatment plan before the patient leaves.
The First Sixty Seconds
As the cliché goes, you never get a second chance to make a good first impression. This truism makes it very important for the doctor to favorably impress the patient from the be ginning, especially when seeing a patient for the first time.
First, consider your appearance. Patients expect you to look like a doctor. Traditionally, this means wearing a white coat, a powerful symbol of being a physician. Conservative dress for women, and white coat and tie, clean shaven for men will create the best impression. The exceptions to the white coat include pediatricians and psychiatrists.
Second, think about your initial behavior. We suggest that you smile and make eye contact. A smile indicates that you are receptive to listening and will be helpful to the
patient. Communication theory has shown that words are only a small part of a face to face encounter. Words impart only 7% of the message that you convey. Voice inflection imparts another 28% of a message, and the remaining 65% is conveyed nonverbally by body language, facial expression, and eye contact.1
Next comes the first touch of the patient, usually a handshake. (And don’t forget the rest of the people in the room.) Use hand sanitizer in front of the patient, tactfully indicating good hygiene. Then sit down so you’re at the same level as the patient, with no barrier such as exam table or computer between you and the patient. This implies that you’re not in a hurry and that the patient has your undivided attention. Sit erect, lean forward, and look the patient in the eye, not at the chart or the computer screen. By so doing, you are using that nonverbal 65% of a message to its best advantage.
Allowing the patient to speak without interruption makes the first few seconds count.
You should start the dialog with nonmedical questions and discussion (e.g., books read, trips taken, interests in common). Once the patient has started talking about his or her symptoms or medical history, don’t interrupt. Let the words flow. In a study of physician/patient interviews, Beckman and Frankel noted that patients were allowed to complete their opening statement without interruption only 23% of the time.2 Doctors interrupted in 18 seconds, on average. Allowing the patient to speak without interruption makes the first few seconds count.
Ask new patients the name of their referral source; and when possible, make a nice comment about the doctor or referral source. Make a note in the chart so you can send a letter to the referrer. If the patient found you via the Inter net or your Web site, ask what words or names he or she used in the search. Keep these as key words, and be sure they’re included in the titles or body of your articles, blogs, and other social media.3 Some doctors give patients a card on which they can write out the questions they will want answered by the time they leave.
With all these steps followed, you will have made a good first impression, and you can go on to the physical exami nation, office testing, and whatever else is involved in the full evaluation of the patient.
The Last Sixty Seconds
It’s now time to discuss your findings and treatment plan. We suggest allowing the patient to be dressed and sitting in a chair while you adopt the same posture and body language as suggested above. Avoid standing over a patient lying on the exam table and covered only with a gown or drape, as this lessens the likelihood of the patient recalling what you said.
After you have presented your findings and plan, conclude by asking if all questions and concerns have been covered. Make sure the family’s questions are answered as well.
Finally, reassure the patient and offer hope regardless of the severity of the diagnosis. Make every assurance that you will help the patient, make him or her comfortable, and avoid pain and discomfort to the best of your ability. Giving hope is a learned skill that many physicians have not mastered. Jerome Groopman, MD, in his book The Anatomy of Hope, points out that a physician cannot impart hope unless he or she believes in it personally. He further says, “I see hope as the very heart of healing. For those who have hope, it may help some to live longer and it will help all to live better.”4 Medicine has seen dramatic improvements in all specialties, and the promise of stem cells, genetic advances, and other treatments makes it very legitimate to offer hope to almost every patient.
The best opportunities to impress a patient favorably are in the first and last minutes of the encounter. If these time periods are wasted, we lose our ability to be effective. Ultimately, we risk losing patients and/or receiving poor reviews.
- Dibble J, Langford B. Communication Skills and Strategies: Guidelines for Managers at Work. Atlanta, GA: Southwestern Educational Pub lishing, 1994.
- Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101: 692696.
- Baum NH, Maley C, Schneider A. Social Media for the Health Care Profession. Phoenix, Maryland: Greenbranch Publishing, 2011.
- Groopman J. The Anatomy of Hope. New York, NY: Random House, 2003.
By Tom Harbin, MD, MBA,* and Neil Baum, MD