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" 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 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, which may be the wrong one.
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 practise that to an art as well), I ask how they've been and what brought them to the clinic. At this time, I'll let them talk uninterrupted for at least two minutes. This may seem counterintuitive in a busy medical office, but it 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 a detailed story that we rehearse in our minds while we are waiting for the appointment.
When patient-physician interactions were observed, it was found that most physicians interrupted their patients within two minutes.
If I interrupt patients, I would have derailed the telling of their story. Crucial details may be missed, and without enough information, we are more likely to miss the correct diagnosis. After my patients explain their symptoms, 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 wellbeing of the patient and the health of the patient-doctor relationship to give that time and to take the time to listen.
In upcoming columns in this series, I'll share some tips on improving communication with physicians.
Do you have some suggestions for how patients and doctors relate? What do you like? What don't you like? How can we do it better? Send comments to me at davidicuswong.wordpress.com.
Dr. Davidicus Wong is chair of the Burnaby Division of Family Practice.
