“Doorknob syndrome” denotes the phenomena of a patient raising a concern—often what is most bothering them—after you assumed the care encounter had concluded (i.e., you were leaving the room). While this may frustrate your ability to stay on schedule, or require you to reopen a closed medical record, it may also flag opportunities to improve clinician-patient communication.
Breakdowns in communication between providers and patients* were found in 22 percent of malpractice cases analyzed¹ from CRICO’s national Comparative Benchmarking System (CBS); more than 60 percent of those cases arose in ambulatory settings. While about 25 percent of provider-patient communication cases focus on the informed consent process, three-quarters relate to the patient’s receipt or understanding of clinical information, or the perception that the clinician was unsympathetic to the patient’s concerns. Cases involving provider-patient communication breakdowns average $169K in incurred losses² and clearly reflect opportunities to reduce missed opportunities to communicate or misunderstandings during those exchanges.
Obviously, finding time is a challenge, but the following tips might help you have a more successful discussion and avoid redundant exchanges, or allegations that an adverse health care outcome hinged on a provider-patient communication breakdown.
Reassure patients who were motivated to seek care due to a symptom they have detected (e.g., rectal bleeding, breast lumps, blurred vision) that you are attentive to their concern—even if you cannot immediately confirm the symptom. Ensure them you understand the specifics of their concern and will help them see it through to a resolution.
Avoid appearing to disregard signs or symptoms that point to an unlikely diagnosis because the patient doesn’t fit the typical demographic profile (too young, no history, “wrong” gender, etc.). Patients “too young” to raise the alarm of a cancer diagnosis are common claimants in failure to diagnose malpractice cases.
Help patients understand the importance of their family’s medical history as a significant marker for your assessment of their risk of certain cancers and other conditions—and decisions about screening and prophylactic measures. They may need your guidance as to what information is relevant (i.e., which relatives, age of onset, certainty of the diagnosis).
Defer discussion of genetic testing to a focused conversation in which you can ensure the patient, and any other potentially impacted family members, fully appreciate the purpose of any testing and consequences of the findings.
Explain how and (if possible) when test results will be communicated to your patients and other clinicians (if appropriate). This can reduce anxiety, phone calls, and breakdowns in the test result communication process.
Listen to how patients respond to negative test/imaging results to understand if they remain concerned. Develop a clear and effective plan (e.g., “If it gets worse or changes, let us know.”) and ensure the patient’s understanding and agreement of that plan.
Make follow-up or test appointments before the patient leaves your office and explain to your patients your tracking and compliance system (e.g., contacting patients a day or two before their follow-up appointments). If a patient refuses follow up, explain the risks inherent is such a decision.
None of these practices guarantee perfect provider-patient communication, but they should give your patients fewer questions to ask as you grab the doorknob.
*These codes also reflect breakdowns in communication with family members present during care.
1. 30,859 claims made 2013–2017.
2. Reserves on open cases and indemnity paid on closed cases.