How do you home in on a patient's most pressing problem without extending the office visit for hours? Dr. Arnold Jay Simon said he asks one simple question, delivered point blank: “What do you want me to cure?”
Patients usually laugh a little bit when he pops his question. But it is also very effective at getting to the heart of what the patient really needs.
When the patient actually answers, he or she is focused specifically on what has the most importance to them, said Dr. Simon, an internist in Palm Springs, Fla. “It's an attention getter,” he said. “Hopefully, it is a way of arranging the problems in a descending order.”
Dr. Simon's practice focuses on geriatric patients, and he has practiced for 25 years. So he is quite familiar with complicated patients. Some physicians are taught to ask, “What is your chief complaint?” That question is fine “for medical students and medical technicians,” Dr. Simon said, but it has always grated on him.
He said he believes that “chief complaint” has a negative connotation, as if you are accusing the patient of whining. It is also jargon that often fails to resonate. His question “strikes a more upbeat chord,” he said.
Moreover, many geriatric patients come in with a caregiver. The question circumvents the caregivers and has to be answered by the patients themselves, and that can open direct communication that might not happen otherwise. “This will start real communication,” Dr. Simon said. “Sometimes the caregiver does all the talking.”
His “what-do-you-want-me-to-cure” question is especially helpful in the first encounter. “But I will use it in subsequent visits to prioritize the patient's problems,” Dr. Simon said.
” 'What is your chief complaint?' does not cut it with my patients,” he said. “All of their problems justify the top rung. The expression 'what's bothering you?' opens the floodgates. But asking, 'What do you want me to cure?' gets you to the gold.”