My previous approach to terminating the encounter with the patient was to ask the patient if they had any additional questions. I would do this before standing up and touching the doorknob. This avoided the scenario of having the patient asking 1 further question when the chart was closed and I had mentally shut down on the encounter with the patient.

By asking if the patient had additional questions, I would occasionally receive a response and be sure to answer their questions before exiting the exam room.

I have discovered a better method of eliciting questions from patients. Let’s assume I am discussing the management of prostate cancer with a man, and perhaps his partner accompanies him for the discussion. Before concluding the visit with the patient, I might say, “The material I just discussed may be confusing. I have thrown out many medical terms, jargon, and acronyms. I know you have questions. Now is an excellent time to ask them and ensure you leave with all your questions answered.” If you pause a few seconds, the patient and partner will almost certainly ask questions.

Using this open-ended comment that validates that the patient and partner may have questions permits them to ask questions. I promise you that this is a more insightful method of allowing patients to ask questions than my previous approach of asking, “Do you have any questions.”

I also suggest reserving certain patients, such as the example of the man with prostate cancer, as the last appointment of the day. If the man is the last patient of the day, it allows you to make a presentation of his options, and there is ample time to answer all the questions that are likely to arise. This differs from the encounter you want to work into the schedule and allow 15 to 20 minutes to provide an ominous diagnosis and treatment options.

If you try this approach, the questions will be more forthcoming. Another benefit of this approach is that you will receive fewer calls and emails from patients after they have left the office, as you have answered their most important questions.

Bottom Line: First impressions count, but so do the last ones. The last impression is a powerful method that most doctors and practices overlook and don’t take advantage of. Combining the last impression with a good first impression enhances the patient’s experience. In other words, the last impression lasts! Don’t let the patient’s final impression of you and your practice be when they pay their bill and check out.

If any of my colleagues have comments or suggestions on soliciting patient questions at the end of the doctor-patient encounter, please let me hear from you.