Consult-Liaison Education Informal-curriculum Lessons Medicine Observations

Informal Curriculum: Lesson 3.

My third recommendation for the informal curriculum about interviewing patients: Respond in the moment to what patients say and do.[1. There are instances when it is prudent to withhold or alter responses. Further discussions about this require an introduction to learning theory. If you want to learn more, please see Pryor’s Don’t Shoot the Dog to learn about reinforcement and how to use that on animals… including humans.] Patients tell physicians information that is difficult to talk about or rarely discussed. If William Osler was correct in advising, “Listen to your patient, he is telling you the diagnosis,” then you must clearly communicate to the patient that you are listening, so he can continue to tell you the diagnosis. The way you respond to patients will affect the amount of information patients will choose to share with you.

You do not need to say a word to respond to patients. A nod can encourage patients to continue with details. A smile can reinforce decisions to change health behaviors. Furrowed brows can express concern. Putting down the pen or stopping the typing can highlight your wish to help the patient. Do you know the color of your patient’s eyes? Taking the second to do that will help you attend to the person in front of you.

Your responses can be utterances. All of those sounds we make that aren’t words can be helpful. The “mm hmm”, “hmm…”, and “huh” take less than a second to utter and tell your patient that you’re listening to them. Example:

I’ve had this pain in my right side for about two weeks. (mm hm) Sometimes it gets really bad and it’s hard to breathe. (hmm) I thought I strained a muscle at first, but it’s just getting worse. (huh)

Patients will let you know if you’re uttering too much: They will abruptly stop talking because they think you’re trying to say something; they will look perplexed; they will ask you if you’re okay. And, full circle: Respond to what patients say and do. Tone down the utterances.

Your responses can also be words. A patient dislocated her shoulder and she feels great pain. She’s wincing, but otherwise quiet. Possible responses:

  • “Shoulder dislocations are really painful.” (acknowledges the pain associated with shoulder dislocations)
  • “Thank you for your patience throughout all of this.” (acknowledges her pain and your appreciation that she is cooperating as best as she can)
  • “How is the pain now?” (responding to the wince)

All of these responses, verbal or not, tell your patient that you are paying attention. We are not in an age (yet) where computers can provide accurate empathy and validation. Algorithms and technology have their place in medicine as treatments; physicians, as people, can provide care. Patients are grateful for care. It is care that acknowledges and respects their humanity, in sickness or in health. This is why people still consult human beings with medical degrees after an exhaustive search on Google.