The Typical Physician Misses Hundreds Of Opportunities To Engage, Empower & Excite Patients Every Day


Did you know that on a typical day in the office seeing patients, the average physician misses hundreds of opportunities to engage, activate patients and excite their patients?

Why?  It’s not because they are too busy.   Research shows it is because physicians don’t have the right patient-centered communication skills and know how.

During the course of a typical office visit, patients provide clinicians with a great many verbal and non-verbal cues indicative of what they are thinking or feeling.   “A cue, whether verbal or nonverbal, is always an indirect signal that a patient uses to try to alert the doctor to a question or concern.  The cue’s value depends upon whether the doctor recognizes and understands the cue.

These cues maybe be relative obvious such as when a patient tells the doctor I am depressed.   But more often than not, many cues are not so obvious but rather hinted at as in their facial expression or body posture.  However expressed, each of these cues represents an opportunity for the physicians and their staff to engage the patient and in turn empower them and excite them.

Take the following physician-patient exam room exchange:

Just in this brief conversation about the patient’s knee, there were at least 4 cues verbally expressed by the patient.  These 4 cues in effect represent 5 opportunities for the doctor to:

  1. demonstrate that they were mindful and listening to the patient
  2. demonstrate an understanding of what the patient expected of him/her
  3. relate to and empathize with the patient
  4. teach patient why an MRI is not necessary at this point
  5. collaborate on a diagnosis and treatment plan the patient can buy into


The intermediate potential patient “fall out” from the way the doctor responded to the patient’s 4 cues includes:

  • Loss of trust
  • Feeling their concerns were ignored/dismissed
  • Feeling that the visit was a waste of time
  • Problem not resolved


Long term potential outcomes might include:

  • Non-compliance in which case problem gets worse
  • Patient dissatisfaction
  • Patient holds back important health information from physician in future visits
  • Patient decides to visit the ER rather than see his physician


Let’s conservatively estimate that the average patient office visit generates 10 such cues…and that the physicians identifies and acknowledges 50% of them.  That leaves 5 missed opportunities per patient visit which translates into 110 missed opportunities every business day (assuming 22/visits/day), 440 a week and 22,880 missed opportunities a year/physician.


Number of Physicians # Of Missed Opportunities To Engage. Empower & Excite Patients & Members Per Year
1 22,880 Missed Opportunities/Year
10 228,800Missed Opportunities/Year
25 572,000Missed Opportunities/Year
50 1,144,000Missed Opportunities/Year
100 2,288,00Missed Opportunities/Year


Now think about the impact physicians in your provider network could make upon patient engagement, empowerment and the patient experience if they were to some basic communication skills which would enable them to be mindful of, acknowledge and respond to these cues/opportunities in patient-centered fashion.  Turns out that investing in improving the patient-centered communication skills of the physicians in your provider network could have quite a significant impact.

The Adopt One! Challenge

An examination of patient cues given…and the physician’s recognition/acknowledgement and response …will be included in the baseline communication skills assessment perform for individual participants in the Adopt One! Challenge.  Be sure to sign up for the Adopt One! Challenge Newsletter.


Nothing in this post should be construed to suggest that not every request for service (as in the MRI) needs to be agreed to. All I am suggesting is that clinicians should take advantage of such request to turn an inappropriate or unnecessary request into a teachable and memorable moment.


Lussier, M.T. Clinicians’ accuracy in perceiving patients: Its relevance for clinical practice and a narrative review of methods and correlates. ., Canadian Family Physician. 2009 December; 55(12): 1213–1214.

Hall, J. Clinicians’ accuracy in perceiving patients: Its relevance for clinical practice and a narrative review of methods and correlates. Patient Education and Counseling. Vol. 84, Issue 3, September 2011, Pages 319–324


  1. Lori says:

    Docotors are “missing the boat” b/c they don’t communicate with each other about their patients that they refer to each other. They refuse to share reports. The patients are left in limbo – with no info, and no way to get the info without PAYING for the report. Why can’t docs communicate about their common patients? Perhaps then they could actually help SOLVE their patients’ issues instead of keeping their patients sick, depressed and on disability. I am a “victim” of the micro-specialty craze sweeping the medical fields. I have seen more specialists in one year than I hae seen in the prior 50 yrs of my life. And have any of them communicated with each other to say, see if ANY of my symptoms are linked or related (hmmm, based on what I know as a former biotech/science person myself, I would say that autoimmune and autonomic problems are likely linked…as could be the pituitary tumor and sudden painful breast growth and horrid depression…and my Raynaud’s…and my migraines…) But none of these micro-specialists will talk to each other. Most of them refuse to send reports to my PCP – and she is the one that REFERRED ME TO THEM!!!
    Talk about missed opportunities – there ya go – that is where the missed opportunites to help patients are originating. How does that oath start again…, oh yeah, “First, do no harm…”

    I wish I had the time and space to tell you how much harm these specialists have caused for me, my family and my quality of life because of their arrogance.

    Thank you for pointing out that the problems with healthcare today are starting with the doctors attitudes and not with the patients – as many doctor-centric blogs do.

    Keep up the great work!!!!

  2. Is it any wonder that doctors miss these cues when they have no formal training on customer service? When do we teach doctors how to,address patient’s fears? When do we teach them to recognize when a patient is afraid?

    Right now, doctors come out of med school thinking that by hanging their diploma on the wall, they have addressed any concerns their patient might have, and answering questions is simply something that can’t be billed.

    Or worse, doctors think customer service is something they outsource to their staff. Never once considering themselves part of the customer experience, when patients consider them to have the lion’s share!

    Doctors are woefully prepared for the *business* of private practice, now we’re asking them to recognize cues for which they’ve never been trained? How’s that fair?

    We seriously need to rethink how we train our doctors if we’re going to ask them to do all this. Pre med in college and med school after rarely leaves time for service-industry jobs where someone would pick up these skills. Yet the industry demands they understand these things intuitatively. Not to mention that if narcotics are any way involved, we also expect them to be cops.

    Is it any wonder why a significant number of doctors say they wish they’d chosen another profession? They’re trained for one profession, and they expected to master 3 more on their own!

  3. Lori says:

    Just blogged about your blog – thought I’d let you know:

    • stwilkins says:


      Thanks for your comments and for you kind words. I also saw your post as well! So glad you found it helpful.

      Steve Wilkins

  4. Alan says:

    While I believe you basic point this article does not prove it. First the patient interaction where you ‘show’ the missed cues is not there. Second you extrapolate without any evidence from 4 cues to 10 in an encounter. Third – you put the onus on the doctor when the patient is MORE than 50% of the equation. It is the patient who has the problem, not the doctor. Training a patient to explain better would be more effective (except that we know that the issue here is the subset of patients who cannot do that – so we have to discount the third point). I completely disagree that the problem is not time – that doctors aren’t rushed. The reason they miss these cues is because they ARE rushed. In the real world communication is repeated until comprehension is achieved. Cues come up more than once. And with more time a doctor would have time to see the cues and understand them. Bottom line – we didn’t hear about these issues in the past because doctors had more time. Yes, more training would help – but not as much as more time. Health isn’t like fast food. Maximizing the number served per hour doesn’t maximize the desired results.

  5. I agree wholeheartedly with your notion that the lack of communication skills is a main reason that physicians don’t empower, engage and excite patients during visits.

    I have found that an excellent way of exciting and engaging patients during the evaluation process is by generating the document during the history and physical via the use of speech recognition software, a Bluetooth microphone and a computer screen which is visible to the patients. As I transcribe hands-free using customized verbal navigational commands I am able to document even while using instruments such as a stethoscope and reflex hammer. It’s amazing how much it seems to generate rapport as the patients see text being printed on the screen pertaining solely to them. Not only does it generate trust and satisfaction that I am listening to them, but it creates a great deal of comfort when I notify them ahead of time to correct me if I dictate anything which is inaccurate or that they disagree with.

    Also at the heart of the matter of the failure to empower, engage and excite patients however, is the fact that many physicians and other healthcare professionals do not possess the emotional intelligence skills necessary to identify, assess and control their emotions and the emotions of their patients. Although emotional intelligence traditionally has been relegated to the field of psychology and psychiatry, it is a very important aspect of history taking in general, and should be an important tool in the diagnostic armamentarium of physicians in general.

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