Primary care physicians encounter a wide range of patient interactions, but some phrases are less welcome than others.
Specifically, the phrase “just one more thing,” often uttered as the doctor is about to leave, can be problematic. While seemingly minor, it can introduce serious issues like new symptoms or treatment-altering side effects.
Dr. Lisa Ravindra of Rush University Medical Center notes that patients often hesitate to bring up important concerns until the last minute. These “afterthoughts” frequently represent the primary reason for the visit.
The problem with “just one more thing“
Dr. Ravindra recalls instances where patients revealed chest pain or mental health struggles right as she was leaving. While it’s better to disclose these issues than to conceal them, the timing can be problematic. Doctors aim to give thorough attention to the most critical aspects of a patient’s health.
Bringing up significant issues at the end of an appointment forces the doctor to make a quick decision: either address the new concern and delay subsequent appointments, or schedule a separate visit. The latter option risks making the patient feel dismissed, especially after they’ve mustered the courage to speak up. Dr. Ravindra finds neither option ideal.
Dr. Melinda Steele, a primary care physician in California, echoes this sentiment. The “just one more thing” scenario is a frequent occurrence that can disrupt her entire schedule. She likens doctors to ducks, appearing calm on the surface while working furiously beneath. Unexpected, significant issues at the end of an appointment add to the stress of managing messages, labs, and patient care.
How to make sure you feel heard
To avoid the “just one more thing” situation, preparation is key. Dr. Steele advises creating a list of concerns, prioritizing the top two or three for discussion. Many patients become nervous and forget important points, so writing them down ensures they are addressed. Urgent symptoms like chest pain or shortness of breath should be placed at the top of the list and mentioned immediately.
It’s also important to avoid accumulating health issues until there are “enough” to warrant a visit. Dr. Steele notes that patients often present a long list of problems because they feel the need to justify taking time off work. Addressing issues earlier can prevent complications and lead to more efficient and satisfactory appointments.
Another suggestion from Dr. Ravindra is to include notes when scheduling appointments online. Many systems allow patients to describe their concerns in advance, which she reviews to determine the complexity of the visit and allocate sufficient time. Patients who are uncomfortable discussing sensitive topics in person may find it easier to communicate them virtually.
What doctors can do
Dr. Ravindra begins each appointment by asking patients about their main concerns and whether there’s anything specific they want to cover. This proactive approach helps minimize the chances of being surprised by last-minute additions.
Dr. Steele recommends that doctors ask patients if they have a list of concerns and review it together to create an agenda. This allows the doctor to identify and prioritize urgent issues, such as moving chest pain from item 15 to the top of the list.
She also advises clinicians against getting too absorbed in the first issue a patient mentions. While doctors naturally want to diagnose and treat problems, it’s best to understand the patient’s full range of concerns and prioritize them before focusing on solutions. This prevents one problem from dominating the entire appointment.
Finally, it’s important to remember that both doctors and patients share the same goal. Dr. Steele emphasizes that patients want to be heard and cared for, and doctors want the same for their patients. Effective communication is crucial for achieving this shared objective.
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