Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Listening to The How Can Reveal The Why


The way patients express their reluctance to pursue screening can help uncover truths that guide meaningful conversations and build trust.   

It’s the first thing on her electronic chart that catches our eye. Perhaps this is due, at least in part, to the renewed vigor with which we help patients meet their screening goals. Highlighted in large, bold red font next to a bold red clock symbol, my student and I notice one incomplete item on her health maintenance checklist: mammography. The patient is a generally healthy 68-year-old woman who hasn’t been to the office in a couple of years. First, we catch up on life events, address a few minor concerns, and discuss the status of her chronic conditions.  


“I noticed you’re overdue for your mammogram,” I said. 


“Yes, I know,” she replied. “I’m really not for those.” 


Her words suggest she must choose “for” or “against.” From wherever derived, she may have strong feelings which require more than a reminder or a lecture. There are many ways to navigate this hesitancy, and I’ve finally landed on one that feels best. 


“I’m interested in knowing more of your feelings about the mammogram. Have you or has anyone you know had a negative experience with one?”  


The richness of what follows makes time stop. 


Years ago, the patient watched her 80-year-old mother suffer through an agonizing process, all of which began with an abnormal mammogram. This led to another mammogram. Then an ultrasound. Then a biopsy. Then surgery. Then a spiraling sequence of painful complications that ended in a horrible death. No wonder she was not “for those.” 


We both acknowledge the trauma of her experience and offer assurance that a mammogram need not place her on a conveyor belt of subsequent tests and interventions if she doesn’t want them.  


“We can walk this path together and stop whenever you want.”  


Then I share a story about a patient of similar age who had a small tumor detected by mammography. This led to limited surgery and probably added many more quality years to her life. The patient says she will think about the screening and leaves with a warm smile and sincere thank you.  


The way patients express their reluctance to pursue screening can help guide us toward meaningful conversations. This builds trust by uncovering fears, needs, experiences, misunderstandings, wisdomall the things that make us human. 





This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.