Two openings—one wrong, one right

“Our goal, if we are to be real healers, is to welcome the patient, show interest and show concern—all in that one opening sentence,” Arnold Melnick, DO, writes.


Here it is. Two actual openings. Two different specialists. Same city. Uttered a week apart.

“Don’t tell me anything. Just answer my questions.”

Obviously, this specialist made no attempt to find out what was bothering the patient. He ignored the brilliant dictum of Sir William Osler, MD: “Listen, the patient is telling you the diagnosis.”

Was the specialist really not interested in the patient, but rather only interested in what he questioned the patient about? How would he determine whether the patient’s complaints were real—or imagined—or exaggerated? Could there be something else in the patient’s complaint to make the physician consider another diagnosis? Or is this physician one who routinely gives patients with a pain in a particular location standardized treatment X but a pain somewhere else standardized treatment Y?

True, this is conjecture, but this physician’s approach would make the patient and others consider all of these troubling possibilities—all adding up to the conclusion that the physician cared not for the patient but for the answers to specific questions.

Then there was the second approach.

“What is your impression of why Dr. Jones wanted you to consult with me?”

What a difference! This specialist asks why the patient thinks he or she is there. What is the patient’s complaint? What aspect of the patient’s illness would benefit from consultation with another physician? From that point, the specialist can continue to explore the patient’s history, previous treatments, results and all of the other medical details needed to make the diagnosis.

While it is possible that the first physician may have intended to follow up on the patient’s concerns later in the visit, his first words created such a negative impression—and maybe turned off the patient’s ability to respond with adequate answers.

There’s an old maxim that a person never gets a second chance to make a first impression. So often if that first impression is a poor one, it may block out later impressions that could turn things around.

We as physicians must be conscious of our first impressions. Patients enter doctors’ offices with a variety of mental states. Some patients anticipate miracles and the presence of an ever-solicitous physician. Some bring with them extreme anxieties. Some patients come with cold distrust. And these are only a few examples. Our goal, if we are to be real healers, is to welcome the patient, show interest and show concern—all in that one opening sentence. What a tremendous challenge for us!

How to establish a firm ground of respect and trust with just a single sentence or two—it is one of the major challenges of medical communication.

I would not presume to offer a universal suggestion. What you say depends on you, your personality, your mode of practice, and the personality of the patient. Suffice it to say, whatever you choose for your opening should reflect interest in and concern for the patient. A few brief examples of suitable greetings include “What can I do for you today? “How are you feeling?” “May I ask why you are here?” A wide variety of openers can fill the requirements.

Then we would have real medical communication—sending a positive message right from the start and not turning the patient off.

And here’s a postscript just to round it out: Keep in mind the best of all visit closers: “Do you have any questions?”

One comment

  1. william faber do

    Dr Melnick gives much wisdom in this short column. How we establish rapport and understanding is at the crux of the physician visit. Our purpose is to strive for excellence in these communications and then clinical success becomes possible.

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