The Diplomatic Way to End the Patient Visit

Greg A. Hood, MD

Disclosures

May 21, 2018

In This Article

Ending the Visit Can Sometimes Be Tricky

I always took it as an odd criticism from my friends that my favorite band wasn't good at ending their songs. How hard can it be to end a song? The average length of a top song on iTunes® is 226.9 seconds.[1] It doesn't seem difficult to end a song that only started about three and a half minutes ago.

But to hear it from patients today, it seems that some of them estimate the average medical office visit to last 226.8 seconds. Although this may be an exaggeration, given the time pressure in today's visit, it's very important to be able to end each visit in an effective and appropriate manner. How can you accomplish this?

Perhaps the initial key to ending a visit appropriately and on time is to start with a clear agenda for the visit. Depending on how well you know the patient, this may require a previsit review of the chart. This, of course, only sets the patient's side of the agenda; the physician may have his or her own plan.

I have found that it's helpful to use a patient agenda form. It's very helpful to make sure that each item a patient would like covered is set for the visit from the outset. These steps help make sure that there isn't an "oh, by the way" moment when you thought the visit was at its end.

Regardless of how charming and thorough you may be in a patient encounter, there comes a point where it's time to end the encounter. Assuming that isn't because the EMS unit you've summoned has arrived, how do you end in a manner that continues the therapeutic vibe and also conveys a satisfying, nonrushed closure?

One key to concluding the visit successfully and on time is to solicit patient participation in the understanding and shared decision-making throughout the visit as it unfolds. Patient studies have consistently found that physicians who engage in a "participatory decision-making style" had better health outcomes, patient retention, and patient satisfaction.[2]

Engaging the patient in the decision reduces the odds that you and the patient are on different wavelengths and only discover this at the moment you thought the visit was over.

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