Patient communication tips: How to handle the tangential patient

Dermatology visits are short. They usually only last 10 to 15 minutes — sometimes not even that long. So how do you handle a patient with a handful of tangential concerns?

The first step is to set realistic expectations —

 even before you enter the room. Empower your assistant who is rooming the patient to set the agenda. Work with your assistant to come up with a script that helps the patient to have understand what your time with them will be like and what can be accomplished within a single visit.

Your assistant should ask the patient, “Why are you here today?” or “What is the most important issue you’d like to address today?”  After listening to the patient, the assistant can set expectations of time: “Dr. ABC will be able to address XY today, and if there’s time, she can address Z, but you may need to schedule another appointment to follow up on that concern.” By establishing expectations about what can be accomplished within a single visit, you will help your patient feel heard and understood when you meet those expectations. If they come in hoping to address 10 different issues and you only cover 5, they will feel short shrifted. Allow your assistant to shape your patient’s expectations so that you are able to spend your time caring for your patient’s health concerns and not managing their expectations.

If, during the visit,  a patient starts to bring up tangential information, ask them how it relates to the reason for their visit. If the tangential information persists after that first redirect, continue to redirect, but use inclusive language. Don’t use “but” to change the subject, instead use “and.” By definition the word “but” is oppositional, and a patient may become defensive. “And,” on the other hand, acknowledges or accepts the tangential information and allows you to redirect the patient back to the main purpose of their visit.

Lastly, but most importantly, be empathetic. Being in a doctor’s office is routine for you — you work here after all. However, seeking health care may be new and even scary for your patient. If you patient is telling you a story about their health, there is a reason they feel it is important for you to hear it. Therefore, be sure to be an engaged listener. Nod your head and ask follow up questions that acknowledge you’ve listened to their story and then redirect your patient to their main health concern.