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    Guest Editorial: Oh, by the way, doctor...we have a new department

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    Sharon T. Phelan, MD
    How many times have you completed a patient visit and started to walk through the examine room door, only to hear the woman say, "Oh, by the way ...."? It's frustrating and challenging at the same time, because you don't know whether your patient's next words are going to signal something you can resolve in a few minutes or are just the tip of a clinical "iceberg." No matter what triggered your patient's question, you now need to move into "triage" mode.

    I pride myself on being approachable—as I'm sure you do, too—and I don't rush patients through their visits even though I try to be efficient. So why does the "Oh, by the way" strategy, used by patients of all ages and backgrounds, still have the potential to bring our best scheduling approaches to a standstill? The answer lies with our patients and their motivations, and our preparation for these encounters. There isn't any definitive literature on this topic, but I think there are four major reasons why patients fall back on "Oh, by the way" as a communication technique. Let's look at these "drivers" and then I'll explain how Contemporary OB/GYN can help you get ready to triage your next "doorknob" consult.

    The first possible motivation that comes to mind when I think about "Oh, by the way" is questions of an intimate nature. These are the concerns that patients are afraid to raise for fear of sounding uneducated or stupid. A woman certainly is not going to share such a personally risky agenda with your receptionist, and maybe not your nurse. In fact, she may need to "check you out" before she even asks you such a question. The fact that your patient will finally blurt it out is either an indication that she trusts you, or a demonstration of how deeply troubled she is by the issue. This "Oh, by the way" may be a problem with her libido, for example, or a concern about exposure to infectious diseases because of a partner's infidelity.

    The next "Oh, by the way" relates to a problem that may be a symptom of a major health crisis. Many patients indulge in "magical thinking." That is, if they treat a symptom or sign as minor, or as an afterthought, it will be minor. That discoloration on a woman's leg is just an age spot and not a melanoma. Fears in this category commonly revolve around cancer, Alzheimer's disease, and heart disease.

    The flip side of this coin is the "Oh, by the way" that, to the patient, seems like such a minor concern that it's not big enough for an appointment in its own right. But since she has your attention, she wants to verify her own diagnosis and perhaps get some guidance as to what type of practitioner she should see if she does need treatment. This is akin to bundling a number of issues into one visit.

    The fourth motivation for an "Oh, by the way" comment is something you said or did during the visit that triggered an idea or question in your patient's mind. An effective conversation, focused on a patient's concerns, will often open the door to discussion about related health issues.

    So, how can Contemporary OB/GYN help you prepare for your next "doorknob" consult? Turn to page 29 for the first installment in our new "Oh, by the way" department. It's specifically designed to help the busy ob/gyn triage offhand patient remarks that can represent clinical challenges. Our goal is to help you provide your patients with the best possible care while maintaining your office's efficiency.

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    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.

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