Female patient w female doctor 848x565 px (Photl)
Photo credit: Photl)

Did you know that on a typical day in the office seeing patients, the average physician misses hundreds of opportunities to engage, activate patients and excite their patients?Why? It’s not because they are too busy. Research shows it is because physicians don’t have the right patient-centered communication skills and know how.

During the course of a typical office visit, patients provide clinicians with a great many verbal and non-verbal cues indicative of what they are thinking or feeling. A cue, whether verbal or nonverbal, is always an indirect signal that a patient uses to try to alert the doctor to a question or concern. The cue’s value depends upon whether the doctor recognizes and understands the cue.

These cues maybe be relative obvious such as when a patient tells the doctor I am depressed. But more often than not, many cues are not so obvious but rather hinted at as in their facial expression or body posture. However expressed, each of these cues represents an opportunity for the physicians and their staff to engage the patient and in turn empower them and excite them.


A typical physician-patient conversation

Take the following physician-patient exam room exchange:

Doctor:  So how are you doing with you exercise since I last saw you?

Patient:  I have been feeling kind down – since I slipped on the ice my knee hasn’t been very cooperative.  I miss the exercise

Doctor:  Well what about your diet? Still sticking with that?

Patient: Yes…but..

Doctor: Well now that the weather’s getting nice perhaps you can get back to jogging like we talked about .

Patient:  What about an MRI of my knee to see if I torn something?  My friend had the same thing happen to her and she had an MRI. She had torn cartilage.

Doctor:  If your knee is still bothering you in a month come and see me.

Just in this brief conversation about the patient’s knee, there were at least 4 cues verbally expressed by the patient.

These 4 cues in effect represent 5 opportunities for the doctor to:

  1. demonstrate that they were mindful and listening to the patient
  2. demonstrate an understanding of what the patient expected of him/her
  3. relate to and empathize with the patient
  4. teach patient why an MRI is not necessary at this point
  5. collaborate on a diagnosis and treatment plan the patient can buy into

The intermediate potential patient “fall out” from the way the doctor responded to the patient’s 4 cues includes:

  • Loss of trust
  • Feeling their concerns were ignored/dismissed
  • Feeling that the visit was a waste of time
  • Problem not resolved

Long term potential outcomes might include:

  • Non-compliance in which case problem gets worse
  • Patient dissatisfaction
  • Patient holds back important health information from physician in future visits
  • Patient decides to visit the ER rather than see his physician


Many missed opportunities

Let’s conservatively estimate that the average patient office visit generates 10 such cues…and that the physicians identifies and acknowledges 50% of them.  That leaves 5 missed opportunities per patient visit which translates into 110 missed opportunities every business day (assuming 22/visits/day), 440 a week and 22,880 missed opportunities a year/physician.


Number of Physicians # Of Missed Opportunities To Engage. Empower & Excite Patients & Members Per Year
1 22,880 Missed Opportunities/Year
10 228,800 Missed Opportunities/Year
25 572,000 Missed Opportunities/Year
50 1,144,000 Missed Opportunities/Year
100 2,288,00 Missed Opportunities/Year


Now think about the impact physicians in your provider network could make upon patient engagement, empowerment and the patient experience if they were to some basic communication skills which would enable them to be mindful of, acknowledge and respond to these cues/opportunities in patient-centered fashion.  Turns out that investing in improving the patient-centered communication skills of the physicians in your provider network could have quite a significant impact.


The Adopt One! Challenge

An examination of patient cues given…and the physician’s recognition/acknowledgement and response …will be included in the baseline communication skills assessment perform for individual participants in the Adopt One! Challenge.  Be sure to sign up for the Adopt One! Challenge Newsletter.



Nothing in this post should be construed to suggest that not every request for service (as in the MRI) needs to be agreed to. All I am suggesting is that clinicians should take advantage of such request to turn an inappropriate or unnecessary request into a teachable and memorable moment.


Lussier, M.T. Clinicians’ accuracy in perceiving patients: Its relevance for clinical practice and a narrative review of methods and correlates. ., Canadian Family Physician. 2009 December; 55(12): 1213–1214.

Hall, J. Clinicians’ accuracy in perceiving patients: Its relevance for clinical practice and a narrative review of methods and correlates. Patient Education and Counseling. Vol. 84, Issue 3, September 2011, Pages 319–324

First Posted at Mind the Gap on 12/11/2013

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Stephen Wilkins
Principal and Founder, Mind The Gap Academy, a thought leader, research, and solution provider company specializing in physician-patient communications, patient engagement, and patient-centered/relationship-centered care. Steve has over 25+ years of professional health care experience working in and consulting with hospitals, health plans, physician groups and solution vendors. The balance of his experience has been in working with provider organizations in the areas of applied consumer health behavior.


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