A 29-year-old man comes to the urgent care clinic for evaluation of a sore throat and nasal congestion. After waiting for 2 hours, he is taken to an examination room. Vital signs are within normal limits. When the physician enters the room, the patient loudly says, "I've been here for hours, and there were barely any people in the waiting room. I'm missing work to be here." In addition to thanking the patient for waiting, which of the following initial responses by the physician is most appropriate?

Question

A 29-year-old man comes to the urgent care clinic for evaluation of a sore throat and nasal congestion.  After waiting for 2 hours, he is taken to an examination room.  Vital signs are within normal limits.  When the physician enters the room, the patient loudly says, "I've been here for hours, and there were barely any people in the waiting room.  I'm missing work to be here."  In addition to thanking the patient for waiting, which of the following initial responses by the physician is most appropriate?

Quizplus · Accepted Answer

Patient-centered communication involves being responsive to the patient's perspective. Initial interactions are particularly important because they set the foundation for the physician-patient relationship. Acknowledging the patient's perspective and being respectful, nondefensive, and nonjudgmental are important for developing rapport and fostering the physician-patient relationship. In this scenario, the patient is upset because he waited 2 hours and missed work, which is compounded by his perception that the wait was avoidable. The best approach is to offer a straightforward apology for the delay, instead of attempting to justify it, and then focus on the reason for the visit. This response keeps the focus on the patient's needs and perspective. (Choice B) This response attempts to justify why the waiting room is empty rather than acknowledging the impact of the delay on the patient. It is likely to be perceived as defensive and does not foster the physician-patient relationship. (Choices C and D) These responses assume that the patient's condition is not serious or urgent. They may also convey that the patient's concerns are being given lower priority and insinuate that the patient made a mistake in coming to an urgent care clinic. A patient who is already frustrated is likely to experience these comments as dismissive and judgmental. (Choice E) Although this statement acknowledges the patient's perspective, it does not attempt to defuse and could possibly increase the patient's anger. Focusing on the reason for the patient's visit is likely to be more productive. Educational objective: Patient-centered communication involves acknowledging the patient's perspective, showing respect, and being nondefensive and nonjudgmental. Long delays are best handled with a straightforward apology and a focus on the patient's concerns. "Best practice" for patient-centered communication: a narrative review. (http://www.ncbi.nlm.nih.gov/pubmed/24404300)

A 29-Year-Old Man Comes to the Urgent Care Clinic for Evaluation