A Patient’s Chief Complaint is Rarely the Problem

Melanie: I hear so many stories from friends about struggling to get appointments with doctors, and waiting for hours to be seen in the clinic or hospital, only to experience an unfulfilling and rushed visit that doesn’t meet their needs. (Getting slapped with a surprise bill later on for services that weren’t covered by insurance adds insult to injury.) I’m always left with the same question: how do doctors know what’s bothering a patient without careful histories or adequate physical exams?

Grandpa: They focus on the so-called chief complaint. In other words, the patient’s brief answer to the first question, “What is bothering you?” often dictates the entire course of a doctor’s actions—from ordering tests and interventions, choosing the specialists to be consulted, deciding which drugs to be prescribed, recommending operations, and even prognosticating about outcomes.

Melanie: I was saying that doctors should cover all of their bases and give patients the time of day. But shouldn’t doctors also trust patients to tell them what’s wrong? Don’t patients know which part of their body is hurting, or if something isn’t normal? Why wouldn’t a doctor naturally follow-up on that basis?

When a Touch is Worth a Thousand Tests

Melanie: Grandpa, the way you practiced medicine seems like another lifetime ago! You talk a lot about the importance of a physical exam in diagnosing all kinds of problems, which is almost non-existent today.

Grandpa: The physical is not merely an anatomic exploration, but also a trust-promoting endeavor. It is the doctor’s most ancient tool.  Beyond providing a wealth of information it is an act of bonding. The hand becomes an adept diagnostic instrument rapidly narrowing diagnostic options.

Melanie: Right, that seems like a joke these days. A medical assistant usually takes my blood pressure, my pulse, and my temperature and tells me to step on a scale, even though I’m wearing my shoes and all of my clothes! (I usually wear some serious heels, too.) One time, I still had a handbag slung over my shoulder.

Hearing More Than Words: The Magic of Listening

Melanie: Okay, we agree that doctors and patients need more quality time together, but you haven’t explained ‘how’ that’s possible.

Bernard: Time doesn’t have to be everlasting for a doctor to be responsive to a patient. It can be stretched through a host of measures—for example, by facing the patient at eye level, by not interrupting a patient’s narrative, and by observing non-verbal cues. These straightforward measures intensify time without extending it.

Melanie: What do you mean by non-verbal cues?

Bernard: Listening doesn’t just merely refer to verbal input. We each possess a powerful nonverbal repertoire based on body language and facial expressions. This may involve a tiny narrowing of gaze, a stare or diversion of eyes, a shrug of the shoulders, a tightening or unfolding of hands, a shuffling of feet, or uncrossing of limbs. Why is a patient looking away or visibly fidgeting? Is she hiding something? What’s going on?