They've come to see you about one thing, and just before you leave the room you hear, "Oh, by the way, doctor..."
by Keith Henaman in Documentation on Monday, February 11, 2019
They’ve come to see you about one thing, and just before you leave the room you hear, "Oh, by the way, doctor..."
This can be a sticky situation. Did the patient simply forget to mention something? Or, did they raise the issue now because they were avoiding an uncomfortable topic? Does the comment pertain to a new health problem, or does it relate to the existing condition?
Whatever the case, because they occur as the visit is ending, you may not give these comments your full attention. What’s more, if you’ve already closed the chart, they might not get documented. Consequently, it would be easy for a doctor not to provide the needed comprehensive treatment, potentially leading to an allegation of failure to diagnose or failure to refer.
Consider the patient whose initial complaint was low back pain, but then casually mentions on his way out the door that he’s also had constipation and difficulty urinating. It would be easy not to inquire further and learn that the patient also experiences frequent urination and occasional blood in the urine, which could be signs of prostate cancer. What can you do to prepare for and minimize these potential time bombs that can arise at the end of an exam? Here are a few tips.
Set the Stage
Your staff can be an excellent resource in getting to the root of the issues with the patient. It can be helpful to ask your front desk assistant to gather all reasons for the visit when scheduling the appointment. The assistant can query the patient: “Ms. Jones, I understand that you’d like to talk to Dr. Smith about recent low back pain you’ve been experiencing. Is there anything else you would like to discuss with the doctor?”
As the doctor, you may find that taking an extra few minutes during the initial visit encourages patients to share their health concerns upfront with you. This can improve what you discover early and reduce the frequency of unexpected, last-minute comments and questions. For example, after hearing the patient’s first concern, provide empathy and ask the patient if there’s anything else going on with his or her health.
Then, summarize what you heard and ask if there anything else the patient would like to discuss with you today. Patients are often intimidated at the doctor’s office. Giving the patient permission to expand on their concerns can be enormously helpful: “Mr. Jones, I know you came here today because you have back pain, is there anything else about that condition that concerns you? Are you worried something else may be wrong?”
Lower Barriers with the Patient
Staying focused, using patients’ names, and making eye contact can help patients feel heard, giving them the confidence they need to get right to the point. It also helps you pick up on nonverbal cues, such as gestures or facial expressions, which can be equally telling.
Showing empathy when talking with the patient can also help establish trust, making patients less likely to repeat themselves or “beat around the bush.” Lean forward during the interview, nod appropriately and keep your arms open.
As you’re doing an exam, talk to the patient about what you’re seeing, so they’re included in your thinking.
When to Reschedule
Many times, the patient’s question or complaint will relate to their current condition. Other times, a last-minute comment could signal a serious, separate issue. For these situations, you need to take extra time to address the condition or refer the patient as appropriate.
However, some patients raise last-minute issues that may be addressed at another visit. In these situations, try telling the patient that the issue they are raising is so important that you’d like to allow enough time to thoroughly discuss it with them. Schedule a follow-up appointment.
For patients who identify a laundry list of concerns, none of which requires your immediate attention, let them know there’s not enough time to address everything that day. Ask that patient which issue is most important to them, and make a note in the patient’s chart to address the other concerns at their next visit.
Benefits of Being Proactive
Knowing the difference between situations that require immediate attention or referral and those that can wait until a later visit can be critical—not only for patient outcomes and satisfaction but also for the proper risk management of your practice.
By encouraging your patients to be forthcoming about their health issues—before they walk out the door—you’re helping them achieve the best healthcare possible. And, meeting your patients’ needs is what risk management is all about.