Don't let the 'doorknob' rob your productivity

October 1, 2006

There isn't a urologist who hasn't experienced the following scenario: The doctor stands up to terminate the visit with the patient, asks the patient if there is anything else they would like to discuss, and the patient says no. The doctor closes the chart, puts his hand on the doorknob to leave the room, and the patient says, "There is one more thing I'd like to talk to you about."

The patient usually relates some personal issue, such as erectile dysfunction, and the doctor offers to discuss this on the next visit. For the most part, the doctor doesn't write this in the chart, and the patient is not likely to bring it up again. As a result, the patient has blown the opportunity to discuss a sensitive, but important topic with the physician.

A physician might also respond by reopening the chart, sitting back down, and proceeding to evaluate the problem, thus delaying him for the rest of the day.

This article will discuss some ways to manage the doorknob discussions that plague every one of us.

Root of the problem

In urology in particular, many patients have a natural reluctance to reveal embarrassing symptoms, such as erectile dysfunction or urinary incontinence, and, as a result, save those questions until you touch the doorknob. A rushed atmosphere can make patients feel uncomfortable about mentioning bothersome issues. It is easy for us to discuss ED with our patients, but it's another matter for patients to initiate that discussion with their physician.

A medical study conducted nearly 20 years ago showed that physicians interrupted patients an average of just 18 seconds into a routine office visit. One of the easiest solutions is simply asking patients: "Anything else?" Just asking that simple question, whether it is at the beginning or end of the encounter, can be enough to prevent the doorknob phenomenon.

Patients can help, too, by writing down questions to ask the doctor before each visit. In my practice, each patient is given a 3×5 card when they check in with the receptionist. The card allows the patient to jot down three questions they would like to have answered on their visit with the doctor. A few patients will ask for several cards and ask a lot more questions. Regardless, this card takes the guesswork out of the visit and allows patients to put into writing what they deem important during their interaction with the physician.

Another suggestion is to have patients complete a health care questionnaire before they see the physician. This can be done in the reception area, the exam room, or electronically from your web site and submitted to the practice before the patient has an appointment. In the questionnaire, you can ask about ED, incontinence, sexually transmitted diseases, or other sensitive issues. Patients will often feel more comfortable putting their concerns in writing than discussing them with their physician.

The patient we see today in most urologic practices is far different from the one I saw when I opened my practice 27 years ago. At that time, I gave him a prescription, patted him on the back, and told him to come back in a few weeks. Patients accepted that limited discussion. Today's patients are much more educated and informed about their medical condition, often coming to the office armed with a stack of articles they have downloaded from the Internet and would like to discuss with me.