Sunday, June 7, 2015

Reading a Patient's Poker Face- the Complex Psychology Behind Every Patient-Doctor Interaction

Patient-doctor communication often has many facets, wrinkles, and twists.  Medical school prepares a doctor minimally for the ups and downs of these patient interactions.

  There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient.  On the job training is sine qua non.  

During and after medical school, it took me several years of practice to hone my skills as a communicator.  I learned some lessons the hard way.
  There was this time in residency when I got called to the program director’s (supervisor) office after I misjudged one of the comments I made to my drug-dealing/drug-using patient. 
The comment was innocuous but it came at a time when the patient was being discharged against his wishes and it triggered an undue reaction.  I still regret it, but it taught me to tread carefully in those types of situations.  

I soon figured out that most of my patient interactions would be a study in psychology similar to that of playing poker and trying to evaluate each opponent’s poker face.  Being able to read a patient’s body language, tone of voice, verbal syntax and use of language (sometimes foul), and mood are only part of the process.  Now that I am five years out from training and well established in practice, I still use this process for all but my best-known patients.    

Whether I am seeing a new patient or a well established patient, I often make small talk initially to gain an insight into the person’s mood, demeanor, level of intelligence/schooling, ability to understand concepts, etc.  You can tell a lot about a person just after a couple of sentences.  New patients obviously can take more time than old patients to get to know and understand their inner workings.  As I sit down and chat, type into my computer (because the government mandates electronic medical record use), check my watch for punctuality (or lack thereof), answer the text from my wife, and countless other tasks at the same time- I often catalogue this introductory psychological assessment in my mind as I prepare to construct my professional interaction that comes later in the form of education and doctoring.  

Interestingly, I have learned that each patient is different, and each conversation with each patient is different…if I see thirty patients in a day of clinic, not a single interaction will be similar.  In addition, a patient who requires hand holding one visit may require a very strict, direct conversation the next time. I have to be prepared to read each person’s poker face and adjust my dialogue accordingly.  

I am an avid poker player and so I like this part of my practice.  I find that sitting at a poker table with a group of strangers and the interactions that follow is not unlike a day in the clinic or the hospital.  That being said, it can be exhausting and overwhelming mainly because it is by no means a perfect science.  

I often hear complaints from patients about my social skills and those of other doctors in the community.  From these laundry lists, there is a resounding group of pitfalls that doctors fall into during their daily patient-doctor interactions.  The following is a short list of those pitfalls:  lack of connection with the patient, talking down to the patient, talking over the head of the patient, rude or crude language, lack of attention to or distraction from the patient’s comments, avoidance or lack of response to patient’s questions, poor listening skills, disinterest in the conversation.  

The goal should be to connect with each patient on a level that best fits their personality type, learning/language skills, education status, socioeconomic background, etc.  There is almost never a time that you will get the Royal Straight Flush (the best hand in poker; and by translation, construct and carryout the perfect patient-physician communication) in a single patient interaction, much less in all or most of our interactions.  

One can only hope to connect, befriend or at least become respected by, and educate your patients as much as possible in each interaction.  

David Jones MD is the owner of, a physician peer rating website, and a private practice cardiologist.  

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