PROTECTING NATUROPATHIC PHYSICIANS

When Your Patient Says Oh by the Way Doctor

You’ve taken the patient’s history, done a thorough examination and initiated a treatment plan. You’re reaching for the door and talking about his or her next appointment when your patient says, "Oh, by the way, doctor..."

These doorknob bombshells are often a quandary for the doctor. Did the patient simply forget to mention something?

Or, did the patient raise the issue now because they were avoiding an uncomfortable topic? Does the comment pertain to a new health problem, or does it relate to the existing condition?

Whatever the case, because they occur as the visit is ending, you may not give these comments your full attention. What’s more, if you’ve already closed the chart, they might not get documented. Consequently, it would be easy for a doctor not to provide the needed comprehensive treatment, potentially leading to an allegation of failure to diagnose or failure to refer.

Consider the patient whose initial complaint was low back pain, but then casually mentions on his way out the door that he’s also had constipation and difficulty urinating. It would be easy not to inquire further and learn that the patient also experiences frequent urination and occasional blood in the urine, which could be signs of prostate cancer. What can you do to prepare for and minimize these potential time bombs that can arise at the end of an exam?

Here are a few tips.

Set the Stage

If you have staff, they can help you get to the root of the issues with the patient. It can be helpful to ask your front desk assistant to gather all reasons for the visit when scheduling the appointment. The assistant can query the patient: “Ms. Jones, I understand that you’d like to talk to Dr. Smith about recent low back pain you’ve been experiencing. Is there anything else you would like to discuss with the doctor?”

As the doctor, you may find that taking an extra few minutes during the initial visit encourages patients to share their health concerns upfront with you. This can improve what you discover early and reduce the frequency of unexpected, last-minute comments and questions.

For example, after hearing the patient’s first concern, provide empathy and ask the patient if there’s anything else going on with his or her health. Then, summarize what you heard and ask if there is anything else the patient would like to discuss with you today.

Patients are often intimidated at the doctor’s office. Giving the patient permission to expand on their concerns can be enormously helpful: “Mr. Jones, I know you came here today because you have back pain, is there anything else about that condition that concerns you? Are you worried something else may be wrong?”

Build in a Last-Minute Review

In addition to the aforementioned “door openers” to better communication, it is wise to leave just a few minutes at the end of the visit for other business. This sets aside time for extemporaneous statements from patients. The doctor can ask, “Is there anything else we should look at in future visits?”

Lower Barriers with the Patient

Staying focused, using patients’ names, and making eye contact with them can help patients feel heard, which may provide them with more confidence to get right to the point. It also helps to observe nonverbal cues, such as gestures or facial expressions, which can be equally telling. With the advent of electronic health records, some doctors are more engaged with their screens than with their patients. Consequently, any sincere human contact goes a long way.

Showing empathy when talking with the patient can also help establish trust, making patients less likely to repeat themselves or “beat around the bush.” Lean forward during the interview, nod appropriately and keep your arms uncrossed.

As you are doing an exam, talk to the patient about what you are seeing, so they are included in your thinking. When a patient focuses on their body in a relaxed and secure setting, it can help them elicit memories about their health, their symptoms and their pain.

When to Reschedule

Many times, the patient’s question or complaint will relate to their current condition. Other times, a last-minute comment could signal a serious, separate issue. For these situations, you need to take extra time to address the condition or refer the patient as appropriate.

However, some patients raise last-minute issues that may be addressed at another visit. In these situations, try telling the patient that the issue they are raising is so important that you’d like to allow enough time to thoroughly discuss it with them. Schedule a follow-up appointment.

For patients who identify a laundry list of additional concerns, none of which requires your immediate attention, let them know there’s not enough time to address everything that day. Ask the patient which issue is most important to them, and make a note in their chart to address the other concerns at their next visit.

Benefits of Being Proactive

Knowing the difference between situations that require immediate attention or referral and those that can wait until a later visit can be critical—not only for patient outcomes and satisfaction but also for the proper risk management of your practice.

By encouraging your patients to be forthcoming about their health issues—before they walk out the door—you’re helping them achieve the best health possible. And, meeting your patients’ needs is what risk management is all about. 

ND Insights is published for NCMIC policyholders. Articles may not be reprinted, in part or in whole, without the prior, express consent of NCMIC. Information provided in ND Insights is offered solely for general information and educational purposes. Names and events are created for illustrative purposes only. It is not offered as, nor does it constitute, legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.


Prepare for and minimize the potential time bombs that can arise at the end of an exam.