Last Comment By The Patient, Oh By The Way, I Meant To Tell You

Hello Homeopaths

I recently read this comment, "There is really only one thing that comes to mind to add that doctors just really hate and patients do all the time:

Do not wait for the doctor to put his hand on the doorknob before announcing another symptom or problem. A good percentage of the time this last minute declaration is the real reason for the visit. Begin the visit with the list of things you want to address that day, then your doctor will know what's ahead of him and can prioritize and handle the issue better within the allowed time.

Waiting until your time has run out isn't fair to you or the doctor or the other patients in the waiting room. No matter how embarrassing the problem, your doctor has heard it before, and will greatly appreciate the opportunity to attack the issue from the start."

Can someone help to give the name of this behavior?

I suppose this discussion could go in the "Interpreting Language" Group. There are two sides to this discussion:

1. From the patients point of view.

S/he is rather shy or embarrassed about a problem.
Maybe it is of an intimate nature?
Maybe they would feel stupid for asking something so silly or simple?
Maybe they feel they have been doing something incorrectly or improper?
Maybe they are uncomfortable with strangers?
Maybe there is someone else in the room with them, so they hesitate to speak up?
What other reasons could they put off in giving this information?

2. From the physicians point of view.

How does the doctor handle when a patient says something so important just as they are leaving the room?
How does the doctor feel when they have spent 1-2 hours already and now another topic is introduced?
How can a doctor make the patient feel during the consultation so that all issues are covered, preempting this activity?
What other thoughts, feelings and relationship building occurs from this type of interaction?
What rubric will the physician use when the patient does this behavior?

Don't forget to give the answer to, "What special name is this behavior called?"

Tags: case-taking, case-taking-methods, comment, doorknob, last, minute, patient, physician, question

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Permalink Reply by Dr. Bruce Arnold on November 10, 2010 at 2:29pm

In my first semester of graduate school, one of the professors talked about this phenomenon. He called it "Door Knob Therapy." I've always thought that was as good a name as any.

As to a rubric, it probably falls under Mind, Anxiety. I do not think I would take it any further by itself. I would look for other symptoms of anxiety and try to get a feel for the over-all experience of anxiety that this patient displays. Is he generally embarrassed by intimate subjects? Does he always procrastinate? Is fear of illness itself so strong?

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Permalink Reply by Gina Tyler DHOM on November 12, 2010 at 6:54pm

I tell the patients to send me a phone message and or email with any last minute updates if they forgot to tell me something during the office casetaking. This way, no loss on both sides, patient is comforted by knowing he/she can add last minute details. I give them a timeline for these add ons. (I mention "after 9:00pm tonight no more adding symptoms") most don't have a problem with that. Let me make something clear; I take appointments during the day and case analysis is done in the evening, this way I give all patients a chance to add last minute forgotten symptoms. Case is reviewed and remedies are prepared and sent that evening or the next day via mail.