Sit down to talk with your patient

Outpatient medicine makes patient physician communication more natural.  When I was seeing patients, we would each have a chair, and have a chat.  The hospital bed can provide a barrier to patient physician communication.

Over my many years of inpatient ward rounds, I have learned the value of sitting down.  We teach this concept in ICM (Introduction to Clinical Medicine), but then most role models on inpatient rotations fail to sit down down.  Most attendings make rounds standing at the bedside.  Most interns and residents stand at the bedside each day as they obtain their history.

Over the past several years, I have made a big point of sitting down to take my histories.  Last week I went in to see a patient recovering from 1 day of DTs.  The housestaff reported that he admitted to only 2-3 beers each day.

After entering the room, I made a big show of finding a chair, and pulling it up to the bedside.  I do this often, making it clear to the patient that I want to chat.  We started talking about his DTs.  Over the next 5 minutes, he told us about a girlfriend who was an alcoholic.  He had been drinking much more with her over the past month, stopping when the relationship ended 3 days prior to admission.  He told us about his previously alcohol detox in 1987.  He discussed his fears and hopes.

He told us the story that we needed to hear, and that he needed to admit.  We developed a plan.  I acknowledged his struggle, and explained that we could not prevent alcoholism, we could only tell him how to prevent alcoholism.

On leaving the room, I debriefed the house officers.  They acknowledged the value of sitting down to chat.  I only hope that they will actually do this themselves.

This rant is meant primarily for hospitalists and ward attendings.  Please practice the art of sitting down with the patient.  Keep your conversations open ended – allow the patient to tell their story.  You cannot rush this process, but you probably will save time in the long run.