Ask 'What else?'
As you wrap up a visit for the problem the patient scheduled his appointment for, the other symptom appears. The "hidden agenda" patient strikes again.
Bad options with the patient visit
The real problem with the patient's "hidden agenda" is timing. He ignores his main concern until the end of the appointment. Only when you're about ready to leave him for your next case, does he spring on you what's really bothering him. Now you must choose between three bad options:
- Falling behind because your visit takes more time than scheduled.
- Putting him off the until another visit, and perhaps annoying him because he feels you didn't address all his problems.
- Putting him off and perhaps missing a serious problem.
Admittedly, you'd rather fall behind a little rather than alienate a patient or ignore a potential problem. But can you manage this situation, so you'll win, too? Most times, you can take just a minute or two at the beginning of the visit and find out what's really on his or her mind. Listen first, then take charge of the appointment's agenda — and, perhaps, those of subsequent visits as well.
After briefly saying hello to a patient, the doctor mentions the official reason for the appointment and then immediately asks, "Is there anything else you're concerned about today?" If the he brings another topic, acknowledge it and politely ask, "and what else?" Keep this up until the patient runs out of concerns.
Such questioning typically takes just a minute or two and gives you a clearer view of what's really on the patient's mind — with most of the scheduled appointment slot still available to address those concerns.
By asking "what else" at the beginning, you can prioritize the patient's concerns and address the urgent ones immediately. If the list is too long for the time allotted, you control the situation better and can steer the patient toward scheduling another appointment to tackle less-pressing issues.
If you're not naturally comfortable talking with patients, develop a little script to get you started. The modest effort to improve your interview skill will prove worthwhile. Those few moments spent interviewing — mostly listening to your patients at the beginning of office visits helps send them on their way satisfied that their concerns have been heard and their immediate needs addressed. It also helps move you toward your next appointment more smoothly.
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