I write this article for you—my colleagues—to share tips from my personal, subjective experience. My hope is that one of these may change the way you relate to your patients and, in turn, enhance one or both of your experiences.
My Six Cents
1. Start with the Social History
As soon as a patient sets foot in a clinic, most hear some version of “Why are you here?” They learn quickly that their chief complaint takes precedence over everything else. But patients are human beings with lives outside the hospital, and curiosity creates the safety needed for them to express themselves openly and honestly.
Instead, I start with “Where’d you grow up?” And if the patient looks confused or defaults to talking about their joint pain, kindly redirect. “We’ll have plenty of time to chat about medical stuff,” I say. “First, I just want to get to know you a bit.”
Ask about family. Ask them how they spend their time and what they like to do for fun. If you like that stuff too, share. Doctors are human beings with lives outside the hospital, too.
2. Invite the Patient to Tell Their Story from the Beginning
When you get to the medical stuff, the most important question still is not, “Why are you here?” Rather, it’s “When is the last time you felt 100% well?”
Many patients will remark that that was a long time ago. Your response? “That’s okay. Start at the beginning and walk me through what’s been happening in your body in the order that you experienced it. I’ll type, listen and save my questions until the end.”
Then, put your money where your mouth is. The details that crack the case may precede the symptoms the patient otherwise would’ve recounted first. But even if they don’t, allowing a patient to tell their story from start to finish—without interruption—helps them feel seen and heard, even if the visit doesn’t end with a diagnosis.
3. Leave Asterisks in the History of Present Illness
When you’re tempted to interrupt the patient to ask for clarifying information, don’t. Simply leave a little asterisk in the history of present illness as a placeholder to come back to when it’s your turn to speak and fill in the blanks at that time.
4. Lead with Curiosity
We all encounter patients who need medications but don’t want to take them. It’s frustrating, but frustration—or worse, contempt—won’t get you very far.
Get curious about what’s in the way of the patient taking medication. Ask them if they’d be willing to share what’s coming up for them when they think about those medications. You may be surprised what you learn.
