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State Your Concern

Updated: Aug 26, 2022

“What’s the patient’s name?” I said.

“I knew you would ask that question!”

I had been called about a new admission, and as I held the phone to my ear, papers shuffled as the doctor on the other end tried to find the sheet with the patient’s name. It made for an awkward moment. After a few seconds the doctor on the other end finally revealed the patient’s name.

We are human.

Sometimes we are busy, and we may feel a bit overwhelmed. During those busy times you may even blank on a patient’s name. When you are trying to communicate with another person, especially when it comes to updating a colleague about a patient’s status, an organized method can help.

I am an internal medicine hospitalist. And when doctors speak to me, on the phone or in person, it’s best if I am focused on what they need. I prefer that the other person lead the conversation by letting me know the reason I am being contacted.

I also think that as a doctor, it makes me look better when a nurse leads with the concern. I have had very qualified and experienced nurses tell me about a patient over the phone, and I am given a history first. But I don’t know why the  nurse is calling.

Usually in these cases once the nurse finishes expressing the historical information, then I hear why I am being called. Since I didn’t get the concern—the reason—highlighted first, sometimes I end up asking questions about history that I may have already heard because I didn’t know what to focus on. I like to think of it as if I am calling a consultant for the first time. If I am calling a cardiologist, for instance, I want to make sure that I state the reason I am calling. I lead with the reason. I could be calling about chest pain, atrial fibrillation, or a pericardial effusion.

Stating my concern first gets my colleague focused on what I need. I prefer hearing the reason first, rather than the history, because hearing the history first doesn’t necessarily focus me on what is needed in the moment.

I have illustrated this concept in my communication method called I-C-FAR. This is an acronym that stands for Introduction/identification, Concern, Familiarity, Assessment, and Recommendation. I-C-FAR is also discussed on my website I have outlined the I-C-FAR method in an ebook and on a pocket reference card.

During a conversation, I also think it’s important to know how to introduce yourself and to identify a patient in the best manner, but that’s for a different blog. Concern is the key here.

I have been in situations in which I have stated my concern—the reason for my call—and it made for a more streamlined conversation. I have found it helpful if I am calling a colleague at 3:00 in the morning, or if I’m talking with a doctor who may be easily distracted.

Sometimes I have called a physician who has a reputation of being mean. I tend to get along with my physician colleagues—but, in those questionable cases, quickly getting to my concern doesn’t hurt.

Specifically in a healthcare situation, if I don’t know a patient, and a doctor or a nurse starts telling me about a patient from a history-first standpoint, I won’t be able to follow along as well.

Think about it. If you are a nurse or a physician who is working with a patient, either initially or subsequently, you start developing a working knowledge about that patient. You might know more about that patient, and you are trying to get me up to speed so you can get what you need. When the concern is stated, I focus on what is needed.

When I don’t know a patient, I have found it very helpful to know why I am being contacted before I hear a patient’s history. This method works even better when I know a patient. When I am familiar with a patient and I know why a doctor or a nurse is calling me—most times the other person can get what is needed much faster.

I have found it helpful when I-C-FAR. What about you?

When was a time that it helped you to know the concern of a colleague up front?

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