"Oh, by the way..."

Associated Press discovers the Doorknob Phenomenon. (The article is curiously similar to my blog post on the same topic, including the phrase "Oh, by the way," and the word "bombshell." No doubt, it's a coincidence....isn't it?) Anyway, they have tips for improving communication between patients and doctors, so important subjects aren't saved until the departing doc's hand is literally on the doorknob.

Doctors' rushed schedules and patients' natural reluctance to reveal frightening or embarrassing symptoms make those questions at the doorknob almost inevitable, but medical schools increasingly are teaching students how to avoid such situations.

Dr. Rita Charon, who runs the narrative medicine program at Columbia University's medical school, said the phenomenon might even be one reason that doctors' visits often don't start on time — the previous patient may have had a doorknob question requiring another exam.

Part of Charon's program encourages doctors-in-training to listen and better "read" patients and their greatest concerns.

"You really have no idea of what part of life is going to come up and you really need to signal some desire to hear about it," Charon said.

Charon teaches a method she has adopted with her own new patients, whom she tells: "'I'm going to be your doctor and I need to know a lot about your health and your body and your life' — and then I stop talking."

She doesn't write anything down, or check the computer — she just listens.

"When I did this the first time, the patient started crying, saying 'No one ever let me do this before,'" Charon said...

Nancy Conley, a 48-year-old secretary in Springfield, Mo., says embarrassment led to her own doorknob questions about chronic constipation, along with a belief that nothing could be done for the condition, caused by irritable bowel syndrome.

She sometimes talked herself out of mentioning it at all, trying to downplay it in her mind during the visit "even though I'd go home to my own little hell," she said.

Conley's advice to doctors for avoiding such resistance is to "slow down."

A rushed atmosphere can make patients feel uncomfortable about mentioning bothersome issues. Instead, Conley said, doctors should take a moment to imagine what it's like to be the patient.

"They're scared, they're taking off work probably to be there ... they don't want to be humiliated by putting on those stupid little gowns. If a doctor just stops and says 'Whoa, how would I feel if I were in their shoes right now,'" that could help break the ice, Conley said.

See also Dr. Centor's excellent post about Doorknob behavior. The phrase "Oh, by the way..." came to my post, via his post. Both posts were inspired by a New York Times article. (You see how convoluted we have become, tracing lineage of blog items...)