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

The “List”


Reviewing patients’ lists of concerns is an opportunity to build trust and partnership. It may also make visits more productive and satisfying for both patients and clinicians. 

Like you, I can spot it the moment I walk into an exam room. It may be scribbled illegibly on a scrap of paper, computer printed and neatly placed on the desk, or shimmering on a smartphone screen that a patient is clutching in front of them. It’s the proverbial “List” of medical lore. 


During the holidays, lists–like those for holiday gifts to buy, cards and invitations to send, or groceries for special feasts–usually evoke excitement for the season. The patient’s list of concerns though, may perennially strike fear in the hearts of clinicians. And the way we respond to it will carry a visit to either a place of stifling conflict or mutual reward. 


It took me some time in practice to realize that a diagnosis isn’t all that patients want from a visit with their clinician. Mostly, they want to feel seen, heard, and, during that brief time with me, my top priority. So, quick interruptions, or saying things like, “We’re never going to get to all of that,” or, “I don’t have time to address all of those things,” aren’t going to go over well. 


It’s much more constructive to view a patient’s list as an olive branch. “I see you have a list–let’s look at it together so I can learn what’s concerning you,” is a great place to start. This builds partnership and trust. Worried that your patient will meander on endlessly? Well, in fact, studies have shown that when allowed, patients rarely talk uninterrupted for more than 90 seconds. And keep in mind that patients may not be seeking a solution to every symptom mentioned. Rather, they may just be looking to see if they provoke the clinician’s dismay. In this case, asking, “What are you most worried about?” may reveal an issue which accounts for most complaints on the list. 


Sometimes there truly is too much to handle in the given visit time. Rather than trying to usurp control, use empathic and patient centric statements. “I wish we had time for all your concerns. How about if we pick your top two or three, and arrange a follow up soon?” or “What are you most hoping to accomplish during your visit today?” are my favorites. This shift in mindset can increase both clinician and patient satisfaction. 


When you spot the “List”: 

1. Take a mindful breath to temper your own emotional reaction. 

2. Show curiosity and view the list as a conduit to trust and partnership. 

3. Remember that patients may not expect a diagnosis for every complaint. 

4. Use empathic, patient-centric language to negotiate a visit agenda. 









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