9 questions every physician should ask before entering the exam room

At a recent magic convention, magician Dereck Hughes made a remark that surprised me: "Magicians are really actors playing the part of magicians." He then described how legendary acting teacher Uta Hagen taught actors to prepare before every performance by asking themselves nine simple questions that helped them understand not only what they were about to say, but why they were saying it.

Medicine isn't theater, yet every time a physician opens the examination-room door, he or she is about to perform in the highest sense of the word: not pretending, but bringing knowledge, judgment, compassion and presence to another human being.

Perhaps physicians should prepare the same way actors do. Before seeing your next patient, consider these nine questions.

Who am I?

Before you open the door, start by asking, “Who are you today?”

Every meaningful encounter begins with self-awareness.

This is more than your specialty or the letters after your name. Are you merely diagnosing disease, recommending treatment and writing prescriptions, or are you also easing the anxiety that accompanies most patients into the exam room?

Are you a technician, a healer, a teacher, a mentor or an advocate?

Every physician wears many hats. On one day you may counsel a frightened patient with a new cancer diagnosis. Later that afternoon you may lead a department meeting, mentor a resident, speak at a medical conference or negotiate with hospital administrators.

Knowing the role you are playing at this moment helps determine how you should communicate and interact with the patient during the encounter.

Patients seldom remember every recommendation you make, their laboratory values or the advice on lifestyle changes. However, they always remember how you made them feel.

What time is it?

Before you open the door, show respect for the patient’s time.

This question is not simply about looking at your watch. It is about respecting time.

Patients often wait weeks for an appointment, only to spend another 45 minutes in the reception area. Every unnecessary delay communicates a message, whether intended or not: My time is more valuable than yours.

Being punctual is more than good scheduling; it is a sign of professionalism and respect.

Time also means recognizing when a patient needs five additional minutes because today's visit is different from every other visit.

Excellent physicians know when to accelerate and when to slow down.

Where am I?

Before you open the door, focus on the patient you are about to see and clear your mind of yesterday’s patient. Being present is impossible if your mind is somewhere else.

Being physically present is easy, but being mentally present is a bit harder. Are you in the examination room, or are you thinking about the previous patient, the upcoming surgery, the overflowing inbox or tonight's lecture? Patients recognize distraction immediately.

When entering the room, silence the phone, close the laptop and, when possible, sit down, be eyeball-to-eyeball with the patient and give the patient your complete attention. Even a brief period of undivided attention often creates the impression that the patient does not have the physician’s undivided attention.

Being totally present is one of medicine's most powerful therapeutic tools.

What surrounds me?

Before you open the door, think about your environment.

Perhaps your medical assistant called in sick. The schedule is overbooked because of a flu outbreak. The electronic medical record is running slowly, or the power is out, forcing the office back to paper charts. In New Orleans, we even prepare for hurricanes.

Excellent physicians understand that medicine never occurs in a vacuum. There are always extenuating factors: problems with patient flow, a difficult patient who requires more time or a terminally ill patient who needs the physician to hold their hand.

What are the current circumstances?

Before you open the door, think about the circumstances of the patient you are about to see.

Every patient arrives with a story you may not yet know. Has the patient recently been discharged from the hospital? Did they spend the night worrying after reading alarming information online?

Are they grieving the recent loss of a spouse or family member? Do they have a sick child at home? Is this a routine follow-up, or the day they learn whether a biopsy shows cancer? If that is the case and you know it before entering the exam room, you will need to be at your reassuring best and plan to spend additional time with the patient.

Understanding the circumstances often explains behaviors that otherwise seem puzzling. Treat the whole patient and not merely the symptoms.

What are my relationships?

Before you open the door, think about your relationship with the patient you are about to encounter.

Relationships with patients determine trust. Is this a patient you have known for 20 years, or a new patient you are meeting for the first time? What is your relationship with the referring physician? How are your relationships with your staff, nurses, advanced practice providers and hospital colleagues? Medicine is like a well-run sports team. Strong relationships improve communication, reduce errors and enhance patient satisfaction.

What do I want?

Before you open the door, consider what you want to accomplish with the patient in the room.

Every patient visit should have a purpose. Certainly, if you graduated from medical school and trained in a residency program, making an accurate diagnosis and prescribing appropriate treatment is the minimum patients expect.

But perhaps your larger goal is to reduce fear, improve understanding of their medical condition, encourage lifestyle changes or strengthen the physician-patient relationship. Success is measured not only by clinical outcomes but also by whether the patient leaves with greater confidence, hope and trust. Satisfied patients become ambassadors for your practice by recommending you to family and friends.

What is standing in my way?

Before you open the door, think about any problems you may encounter.

Every physician encounters obstacles. Some are external: insurance restrictions, prior authorizations, staffing shortages, limited appointment times or technology failures. These are most often beyond your control. Other obstacles are internal, including fatigue, impatience, assumptions, unconscious bias and, worst of all, physician burnout. Burnout has become so common that nearly every physician has either experienced it personally or watched a respected colleague struggle with it.

Recognizing these barriers, both the external ones and especially the internal ones, is the first step toward overcoming them.

What must I do?

Before you open the door, think about what you must do to give the patient a positive experience.

This final question transforms reflection into action. Do you need to ask one more question before making a diagnosis? Should you sit down instead of standing? This is especially true if the patient is wearing a paper gown and lying on the exam table. Patients in this situation are unlikely to remember what you say or the advice you give them.

Should you pause before interrupting? Of course you should. Should you call the referring physician personally? Certainly, if there is a difficult situation or an ominous diagnosis, contacting the referring physician in addition to writing a referral letter is a nice gesture that cements the relationship with that referring doctor.

Should you involve the family? This is important if the patient is a child, a teenager under 18 or cognitively impaired.

Knowledge without action never heals anyone. The finest diagnosis has little value if it isn't communicated with clarity, compassion and commitment.

Patients ultimately judge their experience not by what physicians know, but by what physicians do and how they do it.

Bottom line

Every physician has two opportunities to prepare before seeing a patient. The first is a brief look at the chart. The second is preparing yourself for the encounter to ensure that the patient has a meaningful experience.

Artificial intelligence can summarize the history, organize medications, identify abnormal laboratory values and even draft today's note. AI can generate information, but it cannot generate compassion. AI cannot build trust. Compassion and trust are responsibilities that still belong to us.

Tomorrow, before you place your hand on the examination-room doorknob, pause for just a few seconds and ask yourself these nine questions:

1. Who am I?
2. What time is it?
3. Where am I?
4. What surrounds me?
5. What are the circumstances?
6. What are my relationships?
7. What do I want?
8. What stands in my way?
9. What must I do?

Then open the door. Those few moments of reflection may change not only the encounter but the life sitting on the other side of the door.

Neil Baum, M.D., a professor of clinical urology at Tulane University in New Orleans, Louisiana. Dr. Baum is the author of several books, including the best-selling book Marketing Your Medical Practice: Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.