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.

Comments are moderated before they are published. Please read the comment policy.

  • Ellan

    Also, do not end the visit with a polite “Anything else?” unless you really are interested in something else!

    • PCPMD

      I use it when the visit ends early (it happens, really!). Otherwise, I agree – best not to invite additional issues unless there’s time to address them.

    • Reese

      Reminds me of what nurses who work in hospitals that use “scripting” have to say to patients: “Is there anything else you need? I have the time.” Of course, the nurse doesn’t have the time, but s/he has to ask, lest mgmt. or Patient Satisfaction Gods ding him or her and wind up getting the nurse written up and disciplined.

  • SteveCaley

    NO. No, no no no no! I never let a patient leave the room until they terminate the visit. [OK, almost never. Fire alarms, dangerous manics, and that's about it.] Usually the “one more thing” is the actual purpose of the visit. If I need to churn and burn, I’ll go get another kind of job – I’m about to anyway. Never, never, never miss critical medical information for the sake of feeding the clock. Yes I know how times are nowadays. Scr*w how times are nowadays.

    • querywoman

      If my docs run over, I assume they spend more time with a patient.

    • Trina

      Steve,

      Thanks for the comment. I agree that crucial information is often conveyed at the end of the visit. What docs ask me is how they can address these concerns, yet do so in a time efficient manner. We would all love to spend 1 hour per patient, but unless we are in a concierge practice, we rarely get an hour. My goal is to help docs ensure their patients are still heard and their concerns are still addressed, despite the reality of time constraints. Some docs are pros at this while others struggle. My goal is to offer practical tips for success without compromising patient satisfaction or the doctor’s sanity.

      Thanks,
      Trina
      http://www.patientsatsolutions.com

      • SteveCaley

        Once physicians accept the concept that it is not pragmatic to practice ethical medicine, we change from victims to perpetrators.
        A kind pat on the wrist, a whisper that “I cannot wait until this awful business is over!” That’s what Klemperer wrote of when he encountered an old friend on the street who was a non-Jew. A private assurance of respect and friendship – but hurry along, someone might see you.
        It simply was not pragmatic to have Jewish friends back then. If you were wealthy, perhaps – but that sort of thing could get a working person fired! Or worse! So let’s not get to overboard on this thing!
        Once we tell a patient that we are done with them, that we will not care for them further – not by one’s own decision but in fear of the Clinic System – then we become perpetrators. Anything else is kindly lying – and perhaps that is why patients are becoming so fed up with us. We may forgive ourselves liberally; but the patients are often very stubborn about this.

  • querywoman

    I learned about this stuff when I worked one-on-one with clients in public welfare for much lower pay than docs get.

  • buzzkillerjsmith

    Remember those ejector seats from James Bond?

    Not advice, just an observation.

  • Trina

    Thanks for writing in, Angelina. I definitely think your strategy of making a list is a good one. It helps you and the doc stay focused, and it ensures your doctor addresses those things that you’re most concerned about.

    Trina
    http://www.patientsatsolutions.com

  • SteveCaley

    Yes! One of the skills lost in modern times is efficient, attentive listening. Good poetry is better than bad prose, and it is much shorter, too. Often we listen until we capture an idea, and then close out the patient’s mind and we focus upon that idea, and close the interview when it is properly sketched out. We lose track of the patient that way. It is what we are trained towards in our education; and it is what we must learn how to surpass during our practice. It’s an all-encompassing a problem in our society – it is the air we breathe. Physicians must surpass it – it is hard.

  • Trina

    Thanks for your response. I certainly agree with you that the using some iteration of the patient agenda form is incredibly helpful, both for the doctor and the patient.

    One other good strategy I’ve heard specifically relating to asking questions is instead of asking “Do you have any questions?”, phrase it as, “What questions do you have?” It’s a more open ended question and it helps your patient realize that you understand they have questions and you are more than willing to answer them.

  • Trina

    Thanks for your comment, Leilani. I definitely agree that if you know for sure you cannot address every issue that day, collaboratively working with your patient to set priorities is the next best way to go.

    Trina
    http://www.patientsatsolutions.com

Most Popular