Communication Problems Between Physicians and Patients


Many of my readers are curious about patient question asking behavior during a trip to the doctor. The fact that most of us ask few “important” questions during a routine (or not-so-routine) physician visit seems very counter intuitive.   After all, conventional wisdom (and TV drug ads) are forever telling us to “ask your doctor” or “talk to your doctor.”  It seems like a very logical thing to do.   But you would be wrong.

You see most people are not aware that the “visit with the doctor” is a highly structured, time honored affair.   Physician office visits typically are not like normal conversations. It is not that they can’t be a conversation…it is just that typically they are not.   In a conversation there is a natural flow between participants, e.g., someone talks, and some listens, and then someone talks. During the office visit, patients generally have a very limited “window of opportunity“for telling their story to the doctor.

For more information on patient question asking behavior check out my earlier post.

The structure of the physician visit goes back to the early 1900’s and the advent of the “physician as scientific expert” role.   Consistent with the scientific method, there has to be a process to everything.

In the case of the physician-patient interaction, the process involves the physician guiding the patient through the following 5 steps:

  1. Identify the patient’s presenting problem – this phase is important because it is the only time patients are asked to describe their illness in their own terms and in pursuit of their own agenda.   Problem presentation is normally initiated by physicians’ opening questions and ends when the physician begins the medical history and exam.
  2. Conduct the medical interview (history and physical examination) – In this phase the physician asks the questions and the patient answers.
  3. Diagnose the problem – Here the physician tells the patient what he/she thinks is wrong, including recommending any necessary tests.
  4. Treatment of the problem – This is where the physician recommends a course of treatment, including medications, referrals, etc. to the patients.
  5. Closing – This is where the physician tells the patient when they should schedule the next appointment and then out the exam room door.

The patient’s window of opportunity for “speaking up” during the office visit is often limited even further by the physician interrupting the patient’s opening statement (problem presentation) with a question…which invariable segues into the medical interview without the patient being allowed to finish.

The truth is that most of us are pretty adept at knowing when to speak up and when to keep quite in social situations.   The physician visit is no exception.   A look, a comment or a gesture let us know when the other party (in this case our physician) is interested in what we have to say.   Social norms, i.e., physicians are busy and I shouldn’t waste their time with my trivial question, my doctor will probably think I am dumb if I ask my question, etc. also silence even the most empowered patients among us.

Implications for Patients

As the side bar points out, 28% of medical errors in one physician study were attributable to cognitive errors on the part of physicians including:

  • Incomplete/faulty history and physical examination
  • Failure to consider the correct candidate diagnosis
  • Premature closure (of the visit).

There are steps patients can take to avoid such medical errors.  They include: 1) understanding the process of the office visit from the physician’s perspective and 2) knowing when and how to speak up in a way that will get their thoughts, concerns and desires across in a productive, satisfying fashion.

For more information on patient question asking behavior check out my earlier post.


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