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By Jock Hoffman, CRICO

Related to: Ambulatory, Communication, Emergency Medicine, Primary Care, Obstetrics, Surgery

“No word was ever as effective as a rightly timed pause.”
— Mark Twain

A physician who asks a patient at the end of an appointment or bedside visit if she has “any other questions” is obliged to pause long enough to let her respond. Cutting off the exchange by starting to talk (or walk) too quickly may leave unspoken concerns hanging in the air. Unexpressed questions or worries, in turn, can leave the physician unaware of important clinical details and the patient dissatisfied by her inability to communicate health-related concerns.

Inadequate communication is, notoriously, a trigger for a patient with an adverse outcome to allege malpractice. In a sample of 11,725 malpractice cases from CRICO's comparative benchmarking system, 18 percent of the cases asserted from 2005-2010 cite a breakdown in physician-patient communication. Of those, 54 percent involve outpatients and 40 percent involve a significant permanent injury or the patient's death. While such cases generally reflect multiple contributing factors, the plaintiffs often point to critical questions that their physicians never heard or never answered.

The timing and duration of a purposeful pause can be the difference between being informed or in the dark. Asking for input without allowing the patient a moment to think (or gather his nerve)—or without time to give that input full attention—puts both the patient and the physician at risk. To enable a patient to share a critical symptom, change in health status, or his inability to comply with the treatment plan, physicians who wait silently after they pose that question…and then wait a little longer, may encourage a reticent patient to voice a nagging concern that might otherwise have been stifled.

Of course, once a patient is invited to bring up any secondary issues, patience is a virtue. Physicians may need to suppress the urge to interrupt before the patient has gotten to the crux of the matter. Taking a reasonable amount of time to listen to his concerns, acknowledge them, probe a bit, and propose some follow-up, assures the patient that a two-way communication took place. A less attentive approach may be perceived as disinterest, and will likely be a point of contention if the patient's unspoken, or unheard, concern evolves into an undiagnosed or untreated health problem.

For physicians who sense the need to hone their patient communication skills, opportunities abound. After all, it might only take a few seconds to make a big difference.

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October 1, 2010
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