According to an article published in the most prestigious peer reviewed medical journal in the world, there’s a phenomenon called the doorknob moment.
It’s where a patient waits until the very end of the visit to reveal critical information, right as the doctor is heading out the door.
Oh, by the way, the patient says, I’ve been working a lot of fourteen hour days this summer. Do you think that might have something to do with my bleeding peptic ulcer?
This moment could happen for any number of reasons.
Perhaps the patient feels embarrassed about admitting her issues.
Perhaps the patient feels rushed and doesn’t think she has time to say what’s on her mind.
Perhaps the patient is minimizing her own pain out of denial.
Perhaps the patient is simply scared of confronting what’s going on in her body.
I’m reminded of my own doctor, one of the great listeners in healthcare history. He once told me during a visit:
If you listen well enough, the patients will give their diagnosis, but if you listen long enough, the patients will give the cure.
It’s a healthy reminder that everyone understands themselves at their own unique pace and speed. As much as we’d love to set other people’s goals, we can’t take them where they don’t want to go.
And so, the best way to treat the doorknob moment is with prevention. Removing obstacles to open communication. Creating a question friendly, low threat environment. Especially when there are power dynamics at play.
I’ve heard of nurses handing out index cards in waiting rooms. It’s a simple tactic to help relieve some of the pressure around the dreaded doctor consultation. Patients are allowed to collect their thoughts in advance, write down key questions they’d like to have answered and communicate on paper what might be uncomfortable to express in person.
Of course, you don’t have to be a doctor to experience the doorknob syndrome. It’s a human issue, not just a healthcare one.
Our challenge is creating a space for people to say and hear whatever they need to hear and say.
Even if that means sitting there in companionable silence.
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How are you creating a low threat, question friendly environment?
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