William E. Morgan, D.C.

"Oh, by the way doctor."

Those are the dreaded words that doctors hear as they place their hands on the doorknob to leave the treatment room at what they think is the end of the patient encounter. The patient then tells the real reason that they scheduled their visit. This phenomenon frequently is the culprit that disrupts the doctor's schedule for the rest of the day. How should we respond to these words? If we ignore them, we may miss the most important message this patient has for us, but if we start a whole new history process, our schedule will be in shambles. Why do patients wait to drop this bomb? The patient may either be too embarrassed or scared to tell you (or your staff) earlier in the visit. They may not even know if their complaint is significant. Either way this information could be monumental.

How can doctors capture this valuable information without disrupting their schedule?

If the patient brings something up at the end of an office visit, and you do not the have the time to adequately address their concerns, you can use one of these techniques to gather further information.

• Get their telephone number and call them during a lull in patient flow.
• Have them schedule another office visit.
• Have them wait in your office for a quiet period to address their concern.
• Interact with them via the Internet, when security and laws allow.
• Have them fill out a patient history form before interviewing them.

However, if your patient brings up some ominous symptoms, drop everything and get to the bottom of the problem right away. For example, if a patient has cardiac-like symptoms, profound neurological symptoms, a severe reaction to your treatment, symptoms of thrombosis, or other significant symptoms, then you must consider that office visit to be an emergency visit. Get them to an appropriate provider ASAP.

Lines of Communication

The best way to minimize communication snags is to have a good relationship with your patients that allow unencumbered communication. You, as the doctor, need to allow time at the beginning of each office visit for the patient to speak. If you rush the patient, you are much more likely to receive questions later in the encounter. Be a good listener. You should also schedule periodic re-evaluation appointments. During these re-evaluations delve into the patient's complaints and concerns prior to your examination. As with any healthy relationship, you and your patient should establish communication ground rules.

Ground Rules

The first visit (or visits) should be an opportunity that is set aside to obtain a detailed history and to allow the patient to explain what brought him or her to your office. During this first visit it is important to set the "ground rules" of your relationship: They are to tell you all of their concerns at the beginning of each visit and not wait until the end; they do not need to completely repeat their history every visit, and they are allowed to contact you by phone or e-mail (depending on legal restrictions). They also are required to tell you of all changes in their health.

With patients who habitually bring up problems after you have concluded the office visit, sit down and explain the ground rules of your relationship. Tell them that they can bring in a written list of concerns or send you an e-mail before their visit.

Conclusion

We want all of the relevant information that the patient can provide and we want it at the time that it can do the most good: at the beginning of an office visit. Organize your office practices to capture all of the pertinent information that a patient can provide in a manner that does not interfere with patient flow, but most importantly be a good listener.