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My Clinical Lesson

By John Elfar, MD

In this era of large competing practices and electronic medical records, there are many patients who do not get the benefit of ever meeting a doctor.  They are often surprised when I introduce myself as they are expecting to meet a mid-level provider.

During training, I received sage advice from Dr. John McDonough, a pioneer in microsurgery then working in Cincinnati.  He told me to always automatically apologize for being late – because surgeons invariably run late in clinic. Although my clinics have run close to the schedule, I always include this apology with my greeting on entering a room.  Patients love the feeling that their time is respected.  My fellowship mentor, Dr. Peter Stern is famous for treating patients very well and he also apologizes for tardiness.  These mentors emphasized something during training that is becoming increasingly obscure in our high technology era – that patients are human beings with apprehensions and fears when they seek the help of a surgeon.

Over the years, the implementation of the electronic medical record taught me another related lesson.  Many of the mandated steps in completing the dreaded computer “encounter”, require a doctor to focus on the computer screen.  Some doctors talk to patients while typing and often have their backs turned to the patient.  I found it unnatural to talk to patients while I was doing computer work.  Patients nowadays seem to be conditioned to have their doctor stare at the screen while talking to them, in much the same manner as they have become acclimated to the doctor running late.  However, patients never like it when their doctor is not facing them while talking to them.  Talking to a patient who is physically behind you in a small windowless room while you are focussed on clicking through the required and often perfunctory steps to complete their visit is not the best way.

My solution to this is to apply the same lesson I learned from Dr. McDonough to this scenario.  I simply apologize to the patient for requirement imposed upon me to do some work at the keyboard.  I then sit silently and do that busy work as best I can.  Then I stop and talk to the patients and then, before returning to the computer, I ask their permission to do so.  These acknowledgements tell patients that I will look them in the eye and talk to them – and that I care what they want.  The very fact that this is important to me transmits respect to patients and they show it.

We all want to be looked directly in the eye when we see a physician. Patients appreciate the effort to acknowledge this basic courtesy, just like they appreciate an acknowledgement of their time.  What is surprising to me as I get older is how often patients indicate that their visit was the first time that the doctor even bothered to put aside the computer, or that they cannot remember the last time they actually spoke to a doctor directly.  Patients want to be looked in the eye and they accept it when asked if the doctor can use the computer.  When asked to share my most precious clinical lesson, it is to apologize for both my lateness and the need to stare at a computer – and to look people in the eye while talking to them.  It works wonders for me.

Michael and Myrtle E. Baker Professor and Vice Chair Department of Orthopaedics and Rehabilitation
Director, Center for Orthopaedic Research and Translational Science (CORTS)
The Pennsylvania State University College of Medicine
Milton S. Hershey Medical Center

Comments (2)
christopher english
November 9, 2018 5:30 am

Always good to be reminded of these key interpersonal communication skills. Keep up the great work!


Laureen Coffelt, OTR/L, CHT
November 11, 2018 5:14 pm

Wonderfully communicated, Dr. Elfar. I entirely concur, and I have done everything in my power, to honor what you are doing.
It keeps us human, and has incredible healing capacity for the patient,, by doing just as you do. These small efforts have incredible power .
As a patient, I am quick to analyze how providers handle this. I am quick to give them incredible accolades, through survey, or a Thank You Card, when they do.

In contrast, I am happy to say I recently fired an ER Doctor who was failing me, as a knowledgeable patient, based upon what I knew “could be provided”, in service delivery. I had no qualms of doing so, and left AMA! Thank you and please keep on! – Laureen Coffelt


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