Maximizing the Time

When the physician invites the patient to move to the examination table, there is a cognitive shift for the patient that is explicit and implicit. Explicitly, it is a change of place that conveys that a shift is taking place in the process of the visit. Implicitly, it prepares the patient for the more physical aspects of the visit. It may even be appropriate for the physician to offer assistance to the patient during this transition.

As the physician examines the patient, each action is preceded by an explanation of what the patient can expect to happen next. These brief informative comments build respect and rapport because the patient is more at ease not having to guess what is going to happen. In this regard, each intervention is a request for informed consent. "I am now going to listen to your heart." The implied question is, "Is that all right?" Each statement carries this implied question, which is a way of being respectful and conveying the message that the patient is participating in the actual care being given and received. It is a collaborative and interactive conversation.

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