One more thing syndrome: 4 tips for doctors to stay on time

“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss.

You think to yourself, “No! I almost made it out of the room on time!” You now have a decision to make. Do you tell your patient he is out of time and will have to wait until your next visit? Do you sit down again knowing you are already running late? It feels like a no win situation. If you end the visit without acknowledging the additional concern, your patient will be upset. If you run too late, your next patient will be frustrated by the wait. You begin to wonder if it is truly possible to maintain high patient satisfaction despite a schedule filled with patients suffering from the one more thing syndrome. Absolutely!

We all know patient satisfaction is a hot topic within health care for both inpatient and outpatient providers. Like me, you’ve probably been asked to improve your patients’ satisfaction and the patient experience. What can you do? The following tips show you things you can do right now, so the next time your patient says, “Doc, can I ask you one more thing?”, you can definitively say, “Yes.”

Tips to maintain patient satisfaction even when patients have “one more thing” to discuss

1. Be proactive. One way to discourage patients from saving important topics until the end is to ask them what they want to discuss before the visit begins. There are several ways to do this. You can ask your nurse or medical assistant to gather this information for you when they register or room the patient. You can ask your staff to give all patients a patient agenda form. This form asks patients to prioritize and record exactly what they want to discuss during the visit. Finally, most patients have a smartphone, so encourage them to use it to keep track of their questions and concerns.

2. Stand. Throughout our training, we are taught that sitting increases our patients’ perception of time spent with them. I completely agree. However, when trying to combat the one more thing syndrome, I advocate for standing. The reality is that doctors simply do not have time to spend another 15 to 30 minutes in the room. Unless it truly requires extended time, I recommend you address your patient’s additional concern while standing. Your patient is still happy that you addressed their concern, but standing acts as a visual reminder that the visit is over.

3. Address at least one additional concern. If your patient has several additional concerns, you will have to use your medical judgment to prioritize. Explain why you chose that particular concern as the priority so your patient understands your rationale. Other times, your patient only has one additional complaint, but the differential is huge. Take fatigue as an example. Multiple things cause fatigue, but you can quickly order a couple of tests to begin the workup. Ordering a CBC or TSH only takes an extra minute, but your patient will feel like you cared.

4. Follow the leader. Signal to your patients that the visit is over by inviting them to follow you out of the room. Offer to walk them to the lab or checkout desk. If your nurse needs to enter the room after you, let your patient know that you need to find your nurse to proceed to the next step of their visit. These strategies still allow you to leave the room, but it sends a message to the patient that you care about them and are still working on their behalf even after you step out.

Trina E. Dorrah is an internal medicine physician and the author of Physician’s Guide to Surviving CGCAHPS & HCAHPS.

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