The 4 Words That Drive Your Doctor Up the Wall
Primary care doctors have heard it all—yet there are four words they hope their patients don’t say.
Here’s what happens: During the last moments of an appointment, as the doctor is walking out the door, a patient interjects: “Just one more thing.” It sounds like an afterthought, but it sometimes turns out to be something serious, like a symptom that requires immediate attention or a side effect that changes the treatment plan.
[time-brightcove not-tgx=”true”]“I’ve heard it many times,” says Dr. Lisa Ravindra, a primary care physician at Rush University Medical Center. “I find it’s often things that patients are hesitant to bring up at first, and they’re working themselves up to be brave enough to discuss it. But it’s often the most important thing they came in for.”
The problem with “just one more thing“
Ravindra recalls patients who revealed—as she had one foot out the door—that they’d been experiencing chest pain. Or they were struggling with their mental health and wanted to get her opinion on going on an antidepressant. It’s better to blurt these things out than hide them from your doctor altogether. But the problem is that “we want to be able to pay as much attention as possible to the things that are most important to patients, and that are most important to their health,” she says.
When a patient mentions something worthy of deeper discussion as an appointment is wrapping up, Ravindra has to make a split-second decision: Should she dive into a conversation with them, and be late to see the next patient (and the one after that)? Or should she ask them to schedule another appointment to discuss whatever they brought up? “Then you risk patients feeling dismissed,” she says. “They made the decision to finally talk about it, and I’m asking them to talk about it another time.” Neither option is ideal, she says.
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Dr. Melinda Steele, a primary care physician in California, can relate. “The ‘just one more thing’ scenario happens all the time,” she says. It can throw off her entire day. “Doctors are like ducks: We’re calm and collected on the surface, but we’re moving it under the water,” she says. “We’re getting blasted from all different directions, having to triage things, go through messages and labs, and see patients in clinic. It’s better to not be surprised by a doozy when you’re trying to get out the door.”
How to make sure you feel heard
To avoid falling into the “just one more thing” trap, make sure you’re prepared for doctor’s appointments. Steele suggests making a list of concerns to bring along. Cap it at about three discussion points, and star the top couple things you’d like to discuss, so they get priority over less important issues. “A lot of people come to the doctor’s office and they’re nervous and forget what they want to bring up, so writing it down can offload some of that and make sure the issues are actually addressed,” she says. “If you have symptoms like chest pain, shortness of breath, or dizziness, move them to the top of the list and mention them up front.”
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It’s also important to work on getting out of the habit of what Steele calls “problem hoarding.” There’s no need to stockpile issues until you have “enough” to justify a visit. “It’s pretty common for people to come in with a big list of issues, because they feel like there needs to be enough to justify taking time off work,” she says. “Reaching out to your doctor earlier and tackling issues earlier can definitely prevent complications”—and ensure appointments are as seamless and satisfying as possible.
Another idea, Ravindra says, is to add notes when you schedule your appointment via your online portal. Many systems allow you to enter text describing what you’d like to talk about, and she always reviews them in advance. “Then I have a good sense of, is this going to be a quick, straightforward visit? Or do I need to make sure I allow adequate time?” she says. Plus, people who are nervous about bringing up sensitive topics in-person often feel more at ease putting them on their doctors’ radar virtually.
What doctors can do
At the start of every appointment, Ravindra asks patients: “What’s on your mind today? Is there anything you want to specifically make sure we cover?” That helps reduce the possibility of being blindsided by “just one more thing” at the end of the allotted time, she’s found.
Steele advises doctors ask patients if they brought a list of concerns, and if so, whether they can look at it together while setting an appointment agenda. “Skim it with the patient, because then you can highlight, ‘Oh, I see you have chest pain as No. 15. Why don’t we move that up to the top?’”
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She also urges clinicians to avoid falling into a rabbit hole and going deep on the first issue a patient brings up. “Doctors are fix-it people,” she says. “We’re listening, but our minds are thinking and strategizing, ‘What could be causing these symptoms, and what am I going to do about it?’” Yet it’s best to hold off on problem-solving until you’ve talked through and ranked a patient’s issues by urgency and priority, she tells doctors, so that an entire appointment isn’t accidentally focused on one problem.
Oh, and just one more thing—keep in mind that both doctors and patients have the same achievable goal. “At the end of the day, patients want to be heard and cared for, and doctors want the exact same thing” for their patients, Steele says. “Communicating effectively is going to be the best approach for everyone.”
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