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The Physician's Most Important Tool

Imagine a simple "tool" that helps your physician formulate accurately perhaps ninety percent of diagnostic considerations, enhances the patient-physician "therapeutic relationship", costs nothing extra, has no risk of side-effects or harm, and the use of which itself is therapeutic. Must be too good to be true. No! Such a tool actually exists; it always has, and it is just as important now as it ever was. It is: the CHAIR!! Medical science and good physicians have always supported the concept that the "history" itself-- what the patient tells the physician and what they discuss prior to the physical examination (independent of any tests and procedures)-- is the most important entity in medical practice. The good history will deliver the correct diagnosis(es), or array of rational possible diagnoses to consider, eighty to ninety percent of the time. It follows, therefore, that anything that facilitates the process of communication known as the medical history must be a super diagnostic tool. Communication between persons should ideally be face-to-face, with frequent eye-to-eye contact, unhurried, and at the appropriate physical distance. If the physician is subject to time pressure, detachment, or if he or she stands over the seated or supine patient, the communication process will be compromised. The tool that guarantees that such compromise will not occur is the chair, as the chair essentially forces the physician to listen and communicate properly. A seated physician will look the patient in the eyes, and will give the impression that he or she is ready and willing to take the time to dialogue properly, and to really try to find out what is going on with the patient. There is now respect and reassurance between two equal discussants, each sharing a common agenda. The patient senses it, and the physician-patient relationship finds itself infinitely enhanced. This scenario also applies, of course, to subsequent physician-patient discussions that deal with updates, reviews, treatment strategies, etc; after diagnoses are known. I personally remind myself to make a big deal about the chair whenever I enter a room to see a patent. I make a little melodrama of it: I fuss with the chair, adjust it, reposition it just so, as I drop myself into it with a sense of repose and anticipation-- all to give myself and the patient the signal that I am ready to really listen to and dialogue with the patient. Its quite a tool, the chair.

Eli Goodman, MD

(This piece appeared several years ago on the senior citizens resource website:

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