Sit and listen, wait, and check your biases. These steps describe an approach to patient care that yields powerful results, according to Vu Kiet Tran, MD, MHSc, MBA, CHE. Tran, a family physician who is also board certified in emergency medicine, teaches physicians and medical students practical approaches to increase their job satisfaction and hone their diagnosis and treatment skills. One such approach addresses the challenge of making on-the-spot clinical decisions based on available information that may be inadequate, incomplete, or even inaccurate.
“The more information we can gather, the more accurate the diagnosis and treatment, and the fewer the errors,” Tran says.
Tran’s three-point approach to gathering adequate information and making a more accurate diagnosis begins with active listening. He advises physicians to pull up a chair, sit down, and take time to hear what the patient has to say. Tran notes that this simple change in body language shows the patient that you are really listening and that you care. In turn, the patient is more likely to provide the information you need.
“Active listening is so important,” Tran says. “By nature, I’m very impatient. I’ve learned the hard way how to be an active listener.”
The second point in Tran’s approach is WAIT, which stands for Why am I talking?
Having positive relationships with your patients improves patient care and your job satisfaction. Consider trying this three-point approach to build rapport:
Many times, according to Tran, physicians use a “shotgun approach” when talking with patients, asking questions that elicit a yes or no response. Instead, he recommends asking open-ended questions so that your patients have the opportunity to provide useful additional details.
“Family physicians have been taught this [open-ended] approach for a long time. However, it doesn’t mean we always practice it,” Tran says. “We have a lot competing for our attention, including time and financial constraints. So, we tend to do things fast.”
Unless he needs the patient to answer crucial questions directly, he has discovered that it’s important to remember to “be quiet and listen.”
In the last point of his approach, Tran advises medical students, residents, and physicians to be aware of personal, cultural, and religious biases and put them aside. Biases can interfere with obtaining an accurate diagnosis and making decisions about treatment.
“We don’t realize how our biases negatively impact patient care. And when something goes wrong, we have to ask ourselves, ‘Where did the mistake occur and did a bias come into play?’” he says.
In Tran’s experience, one benefit of his approach is that it promotes a more positive patient experience. Sitting down to actively listen, asking open-ended questions, and putting aside biases have led to better rapport with his patients. In addition, patients who feel they are treated with compassion and patience are more likely to comply with treatment, he says.
Tran’s approach also prevents the development of a challenging physician/patient dynamic that can take an emotional toll.
“[Since] I started taking this approach two years ago, I feel much more job satisfaction,” Tran says. “My patients accept my diagnosis and I’m not bickering with them. I spend less energy, and I’m less tired as a result.”
Written by the AAFP editorial staff.
Vu Kiet Tran, MD, MHSc, MBA, CHE, is medical director for the University Health Network/St. Hilda’s Transitional Care Program, Toronto, Ontario, Canada, and assistant professor at the University of Toronto School of Medicine. Tran completed leadership and management training through the Canadian Medical Association.