How Doctors Think Read Online Free Page A

expressions, his posture, his gestures. Debra Roter, a professor of health policy and management at Johns Hopkins University, works as a team with Judith Hall, a professor of social psychology at Northeastern University. They are among the most productive and insightful researchers studying medical communication. They have analyzed thousands of videotapes and live interactions between doctors of many types—internists, gynecologists, surgeons—and patients, parsing phrases and physical movements. They also have assayed the data from other researchers. They have shown that how a doctor asks questions and how he responds to his patient's emotions are both key to what they term "patient activation and engagement." The idea, as Roter put it when we spoke, is "to wake someone up" so that the patient feels free, if not eager, to speak and participate in a dialogue. That freedom of patient speech is necessary if the doctor is to get clues about the medical enigma before him. If the patient is inhibited, or cut off prematurely, or constrained into one path of discussion, then the doctor may not be told something vital. Observers have noted that, on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.
    Let's apply Roter's and Hall's insights to the case of Anne Dodge. Falchuk began their conversation with a general, open-ended question about when she first began to feel ill. "The way a doctor asks a question," Roter said, "structures the patient's answers." Had Falchuk asked a specific, close-ended question—"What kind of abdominal pain do you have, is it sharp or dull?"—he would have implicitly revealed a preconception that Anne Dodge had irritable bowel syndrome. "If you know where you are going," Roter said of doctors' efforts to pin down a diagnosis, "then close-ended questions are the most efficient. But if you are unsure of the diagnosis, then a close-ended question serves you ill, because it immediately, perhaps irrevocably, moves you along the wrong track." The great advantage of open-ended questioning is that it maximizes the opportunity for a doctor to hear new information.
    "What does it take to succeed with open-ended questions?" Roter asked rhetorically. "The doctor has to make the patient feel that he is really interested in hearing what they have to say. And when a patient tells his story, the patient gives cues and clues to what the doctor may not be thinking about."
    The type of question a doctor asks is only half of a successful medical dialogue. "The physician should respond to the patient's emotions," Roter continued. Most patients are gripped by fear and anxiety; some also carry a sense of shame about their disease. But a doctor gives more than psychological relief by responding empathetically to a patient. "The patient does not want to appear stupid or waste the doctor's time," Roter said. "Even if the doctor asks the right questions, the patient may not be forthcoming because of his emotional state. The goal of a physician is to get to the story, and to do so he has to understand the patient's emotions."
    Falchuk immediately discerned emotions in Anne that would inhibit her from telling her tale. He tried to put her at ease by responding sympathetically to her history. He did something else that Roter believes is essential in eliciting information: he turned her anxiety and reticence around and engaged her by indicating that he was listening actively, that he wanted to hear more. His simple interjections—"uh-huh, I'm with you, go on"—implied to Anne Dodge that what she was saying was important to him.
    Judy Hall, the social psychologist, has focused further on the emotional dimension of the dialogue between doctor and patient: whether the doctor appears to like the patient and whether the patient likes the doctor. She discovered that those feelings are hardly secret on either side of the table. In studies of primary care physicians and surgeons, patients