At the end of a session for, say, indigestion, the patient and doctor decide on a course of action. Thinking the visit is over, the doctor moves towards the door, at which point the patient, with some panache and the dexterity of a Las Vegas black jack dealer, draws "The List," from their pocket along with an announcement that they have more questions.
Already running late, with many scheduled encounters ahead, the physician suddenly experiences a nascent desire for a career change, perhaps lion taming.
Already running late, with many scheduled encounters ahead, the physician suddenly experiences a nascent desire for a career change, perhaps lion taming.
"The List" varies in style and form but aficionados have apparently agreed upon a number of, until now, unwritten rules.
1- There can be no fewer than five questions on any list.
2- Pencils are the writing tool of choice and the smaller the piece of paper the better.
3- The list must not be revealed at the beginning of the appointment.
4- Issues raised on the list must have been present for no less than five years.
5- It is required that the patient's major worry is placed last on the list.
The doctor who decides to extend the appointment to address the list faces the distinct possibility of mayhem in the waiting room from patients, who correctly believe their time is as important as the physicians, protesting loudly.
What to do? The key is to commandeer the list as quickly as possible to make sure there are no alarming elements that need immediate attention.
Then, the practitioner needs to discern just how concerned the patient is about any of the listings.
The first step, in my experience, is to tell the patient that their appointment time is up. This is hard to say but fair given that their stated reason for coming to the office was addressed in the scheduled time. Additionally, it is unfair to delay subsequent patients short of an emergency or pressing contingency with the current patient.
Then, most tellingly, the patient is asked if they wished to make a special appointment to focus on the list. If they said yes, then I knew the issues needed my undivided attention. If no, they were probably mostly curious, wanting to economize and get as much out of the appointment as possible.
Over many years, very few of my patients accepted the invitation to set up a special visit to address the list.
With soaring health care costs and co-pays, it is a small wonder that some individuals might try to get as much into an appointment as possible. However, in doing so, they do themselves a disservice. A bloated agenda, conducted by a doctor now on the run, will invariably not lend itself to thorough and responsive care.
Mission essentially accomplished. With the element of surprise contained and a galloping list corralled, clinical balance is restored and a sensible and reasoned approach to the list emerges.
Indeed, this problem can be headed off by a "List" savvy doctor asking at the beginning of an appointment if there will be other questions, some possibly more immediate than the declared reason for the visit.
So, while "The List" presents a formidable challenge for the practitioner, it can be managed with candor and understanding. Lion taming still remains a possibility but, for the foreseeable future, the notion can be stored away in a vault for safe-keeping and possible future deployment.
Then, the practitioner needs to discern just how concerned the patient is about any of the listings.
The first step, in my experience, is to tell the patient that their appointment time is up. This is hard to say but fair given that their stated reason for coming to the office was addressed in the scheduled time. Additionally, it is unfair to delay subsequent patients short of an emergency or pressing contingency with the current patient.
Then, most tellingly, the patient is asked if they wished to make a special appointment to focus on the list. If they said yes, then I knew the issues needed my undivided attention. If no, they were probably mostly curious, wanting to economize and get as much out of the appointment as possible.
Over many years, very few of my patients accepted the invitation to set up a special visit to address the list.
With soaring health care costs and co-pays, it is a small wonder that some individuals might try to get as much into an appointment as possible. However, in doing so, they do themselves a disservice. A bloated agenda, conducted by a doctor now on the run, will invariably not lend itself to thorough and responsive care.
Mission essentially accomplished. With the element of surprise contained and a galloping list corralled, clinical balance is restored and a sensible and reasoned approach to the list emerges.
Indeed, this problem can be headed off by a "List" savvy doctor asking at the beginning of an appointment if there will be other questions, some possibly more immediate than the declared reason for the visit.
So, while "The List" presents a formidable challenge for the practitioner, it can be managed with candor and understanding. Lion taming still remains a possibility but, for the foreseeable future, the notion can be stored away in a vault for safe-keeping and possible future deployment.
The "List", perhaps, gives a patient a sense of empowerment in an otherwise unavoidable asymmetric relationship. I find that allowing the patient to prioritize the items of concern helps both patient and doctor - and potentially warding off a career change :-)
ReplyDeleteI'm not sure its empowerment the list provides, but agree with Cha Sen thqt prioritizing the list is key for both patients and doctors
ReplyDeleteAdditionally, the lists ability to bolster a failing memory is significant, making it, for that reason alone, a valuable tool.