10 things patients need to hear at every visit

We've all met one of them: the sage physician, in the prime of his career, who seems to do everything effortlessly. Although he sees more patients than anyone else, he's always on schedule. His satisfaction scores are off the charts, and each holiday season, his grateful patients line up with cards and notes of appreciation. As a young physician, consumed with the minutiae of getting through a schedule and making a diagnosis, I used to wonder: How do they do it?

The answer: These wise physicians have come to realize that all the things we spent years concentrating on-physical exam signs, medication dosages, and treatment protocols-are only the tip of the iceberg. What being a physician is all about is interacting with patients, engaging their trust and respect, and ultimately filling their medical and emotional needs.

The sage physicians have developed tricks for getting to the heart of the problem, for empowering their patients, and for keeping the encounter on target. Over the years, I've collected these tricks of the trade from experienced physicians. They boil down to 10 things each patient needs to hear from us at every visit. Of course, patients we see frequently don't need to hear every one of these things every time. But those who come to us only once or twice a year certainly do.

1. "Welcome to the practice."

This one is a no-brainer. Each and every patient has a choice when she schedules a doctor's visit. Small, inexpensive measures like this can make the difference between a patient coming back or not, and between telling her friends about the good experience she had with us or the bad one.

2. "What are the two most important issues you would like to cover today?"

We all know that feeling of dread: You're 15 minutes behind and you step into Mr. Smith's exam room for a double-booked visit billed simply as "Med Check." When Mr. Smith stands to greet you, you spot in his hand a long list of problems and questions he'd like to discuss.

Many young physicians believe that they must answer all of their patients' questions in each visit. This is simply not so. Patients generally are very understanding of our busy schedules, and they know that we don't like to keep other patients waiting. I usually just explain at the outset that I want to have enough time to deal with each issue thoroughly, but that the visit has been scheduled for only a short amount of time.

After we've discussed their most pressing problems, I invite them to schedule another appointment to deal with any other issues. I've never had a patient express unhappiness with being asked to table his questions for another day. With this approach, we both win: I stay on schedule, and my patients never feel rushed through their time with me.

3. "What do you plan to do about your condition?"

Psychologist Fred Craigie from Augusta, ME, sees some of the most challenging patients imaginable. Each day, his schedule is filled with people who have crippling mental illness, economic disadvantages, and poor social support. Yet his patients improve with his help. How does he do it?

Craigie has learned to empower his patients, a process that begins with the message that they have the ability and the responsibility to make changes for themselves. Our patients often have the attitude that they come to us so we can fix them. By reframing the discussion of the treatment process, we can help share the load of responsibility and also give the patient a dose of reality. After all, the patient is the one choosing whether to exercise, lose weight, or quit smoking.

By asking the right questions, we can help our patients enjoy the empowerment that comes from accepting responsibility for their health decisions.