Do You Know How To Establish Patient Rapport In 90 Seconds?

Shut up and listen.

That’s it. Just be quiet and let the patient talk, completely uninterrupted, for the first 90 seconds. I call it the 90-second rule. If you can’t handle 90, try at least 60 seconds. This regularly shaves 2 minutes OFF my entire visit time, and the patients feel better cared for and the rapport is stronger, because they feel heard.

All you have to do is look interested, even if you aren’t. Look the patient in the eyes and stay quiet for 90 continuous seconds while they talk. If they run out of things to say before the 90 seconds are up, ask them “anything else?” and keep listening.

Patients talk for an average of 60-90 seconds, and then they stop; it’s like a miracle!

Physicians average 18 seconds before they interrupt the patient after entering the room, and we nurse practitioners aren’t much better. But patients often come to us not for a diagnosis, but because they feel listened to by us, they know nurse practitioners have better “ears” than doctors do.

But we nurse practitioners are falling down on the job, too.

Yes, you can chart while listening, as long as you are looking at the patient as well. Set the computer in a location where you can change your view between the screen and the patient easily. That way, you can write down the gist of what they are saying, forming the beginning of your HPI, and still look at them often enough that they can tell you are “present” in the room with them.

Patients can tell when we’re listening. Honor that, and them, by doing so.

Why Don’t We Listen?

I won’t bother justifying it. We all know it’s wrong to not listen, but it’s so hard sometimes. We feel like we can’t, or don’t have time. We’re stressed by demands from administration, insurers, patients, coworkers and ourselves to produce value in the ever-shrinking office visit. We have too many other patients’ problems in/on our inboxes, voice mails and our heads, and feel burned out from our work taking over our personal lives.

That’s okay. I get it; I absolutely know the feeling. The good news is that this method saves time by decreasing the overall visit length.

When you take the time to listen at the beginning, visits run smoother, because the patient feels heard. They’re not constantly trying to interrupt you or feeling upset because you didn’t hear their “real” concern.

What Is The Patient’s Real Concern?

Could I have lung cancer?

A 64-year-old White man presented for his same-day urgent visit for a mild cough x2 days. I figured I knew what he needed for such a simple acute issue, but I gave him the 90-second listening treatment anyway, and I am glad I did.

He talked rapidly but vaguely for thirty seconds about the cough itself, and then he paused. He was waiting for me to jump in and start speaking but pleading me with his eyes to not do so. I could tell there was more coming, so I just looked at him expectantly and nodded, still listening.

He started talking again, slower and more carefully, and said “my best friend got lung cancer last week, and it scared me when I started coughing because that’s how he found out. About the cancer, I mean. The doc said he had cancer because he had a cough. I just want to make sure I don’t have lung cancer,” Then he abruptly stopped talking, and kind of hugged himself disconsolately.

He was a healthy nonsmoker with no occupational exposures, no hemoptysis, no sudden weight loss, no fever or chills, no fatigue, no shortness of breath or dyspnea, and just a mild cough for 2 days. The entire visit took approximately five minutes, and he left elated, and better informed on danger signs to watch for in lung cancer.

He only told me his real concern because I heard him genuinely.

Can I Use The 90-Second Rule With My Friends?

This “let them talk” approach works in just about any situation. Obviously the timing is different for different situations, but I use this “hear them first” method as much with family, friends and coworkers as I do with patients, and it works wonders there, too.

A friend relating that a parent just died and a friend talking about their kid skinning their knee clearly have enormously different listening needs, and I adjust the approach as appropriate for each situation. But it almost always helps when we immediately meet their intensely human need to feel heard.

I Can’t Possibly Use The 90-Second Rule With Emotional Vampires, Can I?

I bet you are annoyed at me right now, thinking: “okay Samantha, I get it. Listen to the patients. I can do that. But what about the patients who are determined to tell me every single problem in their entire life, and try to make me fix all of them, especially the nonmedical ones? This method can’t work with them… can it?”

Yes, it can.

However, I am out of space, so I will share the hows and whys and wherefores in next week’s blog post.

Until then, Take Care Of You!


PS: If you want to delve deeper into patient communication and my “90-second rule,” I write about it under “Boredom” in Day 17 of the Burnout Recovery Guide.

PPS: Another excellent resource on patient communication is the American Academy of Communication in Healthcare