How do you wrap up a patient encounter tactfully?

I am looking for a training program or advice on how to help physicians tactfully wrap up a patient information encounter. Often patients identify the physician visit as a social visit when the physician is operating on a schedule. What has been successful in your group to strike a balance between appropriate patient care, and social visit?

Answers

Soft skills that the physician should have I think they should also be educated about the different cultural differences specially here in the US so they can connect better with patients and make them feel comfortable
I conduct workshops for diversity management and communication/ leadership skills you wont believe the difference.

The best communications course out there is Crucial Conversations http://www.vital smarts.com. There is a place in Florida that the Docs can go to and receive CME's credit. Vital Smarts is only to glad to set up a course for the entire hospital or practice but the CME's come out of Florida. If you would like me to I can do a little research and find the web site.

Sometimes asking the patient "are there any other questions you have for me?"
Many times, the answer is "no". then you can gracefully say "well, it was nice seeing you again, be healthy....(or I hope you feel better)

If the answer is yes, you can say "wow, it seems like you have lots of concerns about your health. Maybe we can set up an appointment where I can devote some time to address (give the specific question or concern)

All of my care is patient care, not social. As a result, psychologists are trained to tactfully end sessions, even when people, as they often do, dump out something huge in the last three minutes. So I might say something like this is a topic we will need a lot of time for and we're almost out. Let's be sure to discuss this first thing next time. You might want to journal about it this week. So, I've set boundaries with the patient, respected the time of my next patient as well as my own to chart in between sessions, and validated how important it is for them, but closed them down and built them up enough to leave my office safe and heard. So my recommendation would be to look at psychotherapists as well. We do this all day long and can be of great help.

Thank you for asking this question. This is a truly big issue.

The way I see it, most patients are not looking for “social” connection with their doctor, but a more holistic connection that includes the body and mind. And it’s here the crux of the matter: Some of the greatest doctors are great at performing operations or treatment, but when it comes to the area of “feelings” they may be unable to cope with the emotions and as a result they appear to be somewhat lost, evasive or even distant.

I like you to think about the following question for a moment: what would be your “personal” reason for a particular choice of your doctor?

After all, most of us would like to have a say in the choice of the doctor who treats us. After all, this is such a personal thing, right?!
There are those of us who will (for various reasons) absolutely want to be treated by one particular doctor only.

And yes, even if a patient does not have a say in the choice of a doctor, chances are that the patient places a lot of hope in the doctor’s ability to help him or her to get well again.

Why is that so? Why are we “personal” about this issue?

Today there are many ways doctors can (re-)learn to work in a more holistic manner with their patients. There are plenty of choices of workshops, coaching programs and the like to help the doctors “renew” themselves and grow emotionally/spiritually so as to better cope with the “personal” (not so much social) aspect that come with this profession, and in return they can give more and needless to say - achieve yet better results.

This is an excellent question and one that has a significant impact on healthcare information technology delivery. Tactfully ending the patient encounter is paramount to a successful practice. After all, we tend to remember the beginning and end of any event and if the end of a patient encounter is negative, the whole experience tends to be viewed as such. To combat the negative patient experience, some medical programs are providing additional training in how to address this problem. During my training we referred to it as the “just one more thing…” question and spent significant time practicing how to best deal with wrapping up the interview. Unfortunately, this question often has a significant implication beyond just the social aspects. For instance, “Doc, there is just one more thing, what do you think about this ____?” Suddenly the entire diagnosis and treatment plan from the visit have changed because this vital information had been previously omitted. One of the more successful techniques for me was to summarize the patients concerns, diagnosis, and treatment plan. This 30 second exercise communicates to the patient that the physician had been listening and is working with the patient to address their concerns. I have found that it is much easier to end the encounter when the patient feels like all of their concerns have been addressed.

In lieu of a formal “training program”, mirroring another physician or role playing can be particularly revealing training devices. Physicians are trained to analyze and evaluate data; videotaping a role- playing patient encounter may reveal problems the physician was not aware of. Also, an in-depth evaluation of the physician’s overall encounter with the patient may reveal areas for further improvement. For instance, by starting the patient encounter with several open-ended questions allow the patient to voice all their concerns. To continue with the previous example, open ended questions could reveal diagnosis changing information earlier in the encounter. This would alleviate the “just one more thing” question.

Unfortunately, some physicians are resistant to change. In that case, one of the more practical ways of dealing with this issue is to identify those patients that habitually ask the “just one more thing” question and schedule more time for their visit. This approach allows the physician the time to adequately address the patients concerns without disrupting the rest of the day. Lastly, I agree with a previous writer, that many patients are looking for a more holistic approach to their treatment including alleviating any last minute concerns they may have. Allowing adequate time for this patient/doctor interaction can go a long way toward solidifying the relationship.