3 steps to productive physician-patient dialogue

Sometimes the best a primary care physician can do for a patient is simply to have a conversation, according to an opinion piece in MedPage Today by Andy Lazris, M.D.

"The visit should not include a lecture or statistics that diminish the complex needs and wants of the person sitting in front of us. Primary care doctors who care for the elderly and chronically ill confront a plethora of medical problems in virtually every patient who walks through our doors," he wrote. "To solve them all is not possible and may not be what the patient wants."

Therefore, as an alternative to a physician-driven appointment agenda, Lazris recommended the following steps:

  • Let the patient speak first. Allow patients to explain their own health concerns. This may mean addressing complaints such as incontinence or back pain before more medically urgent matters such as high blood pressure, but respecting patients' priorities is the only way to ensure patients will listen to physicians' advice in turn.
  • Take your turn. Don't forego the subjects you want to address, especially those tied to Medicare quality indicators, but tell patients you will discuss them at your next (and not-too-distant) visit.
  • Provide food for thought. Give patients information about these upcoming topics (e.g., statin use, mammograms) to review on their own between appointments. Once patients have a chance to review this data, they are equipped to make a more rational decision of whether to pursue a test or intervention.

Although conversation-centric primary care may appear incongruent with pressures to shorten visits and achieve high scores on various quality indicators, it in the long run offers more satisfaction to patients and saves healthcare dollars through enhanced patient health, Lazris concluded.

To learn more:
- read the opinion piece