Doorknob Moments

Doorknob moments. All clinicians have experienced them.

The doctor takes a history and does an exam, comes up with an assessment and plan. Just as the doctor prepares to leave, with his or her hand wrapped around the doorknob, the patient asks one more question -- "Could this be related to falling down the stairs?" --  or mentions one more detail --  "I forgot to mention that I've noticed blood in my stools." -- that changes everything.

Perri Klass, MD, is a pediatrician and prolific journalist. Her 2008 essay titled "The Moral of the Story" is must-reading for anyone interested in modern doctor-patient relationships.

It's the story of a young pediatrician caring for a toddler whose mother brought her baby in for evaluation of fever and vomiting. Everything looked and sounded like a simple viral ear infection until, as Dr. Klass prepared to leave the room, the mother asked, " “It couldn't be that this was from falling down, could it? From falling down the stairs?”

This well-crafted story written in a medical journal highlights the need for clinicians to be paying attention and listening for the real story of why a patient comes to the doctor. It validates the grief of clinicians who lose patients despite well-reasoned, compassionate care.

But the key message is valuable for clinicians and patients alike: “Medicine is knowledge, judgment, experience, and luck...” 

Modern medicine is an art based on science. I hope you can find a few minutes to read this story.

[Update March 2015] This blog post is mentioned in an article by Sandra Boodman:

• The Washington Post:Teaching doctors how to engage more and lecture less 
• CNN:Instilling empathy among doctors pays off for patient care

Comments

[Phil Donnelly Rooney]

I had one where an otherwise healthy young man announced at the last minute that he was too breathless on stairs. He had a pleural effusion from primary TB