- The Washington Times - Monday, March 28, 2005

CHICAGO (AP) — The four familiar words physicians always dread come when the office visit is ending, the doctor’s pen is clipped back onto the white coat pocket and the doctor’s hand is reaching for the door.

“Oh, by the way,” the patient says. What comes next could be as innocuous as a harmless freckle — or a bombshell.

“You’re walking out the door and they say, ‘Oh, I’ve got this chest pain I meant to tell you about,’ so you have to go back into the room and start over again,” said Dr. John Bonavia, a family doctor at River Glen Medical Clinic in Milwaukee.

Doctors call it “the doorknob phenomenon.”

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 College of Physicians and Surgeons, said the phenomenon might even be one reason that doctors’ visits often don’t start on time — the previous patient might have had a doorknob question requiring another exam.

Part of Dr. Charon’s program encourages doctors-in-training to listen to and better “read” patients and their greatest concerns. She teaches a method that she has adopted with her own new patients. 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,’” Dr. 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.

“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, Miss Conley said.

Dr. William Harper, an internist who teaches communication skills to University of Chicago medical students, said “Doctors, including myself, don’t do a good job of getting a sense at the beginning of the medical encounter what the needs are of the patient.”

Dr. Harper tells students that one remedy is simply asking patients: “Anything else?”

“Just asking that simple question, whether it be at the beginning or end of the encounter, can be enough to prevent the doorknob phenomenon,” he said.

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