Eli Goodman, MD

Medical Insights

The cornerstone of all medical science and practice is internal medicine. Its principles should be readily available to all adults, especially in today's chaotic medical environment, which is full of complexities, inefficiencies, and difficult access issues. Take advantage of Dr. Goodman's expertise based on his 33 years' experience in virtually every medical situation and setting. [Editor's note: Dr. Goodman no longer contributes to Silver Planet, but we have made his archived blog entries available as a service to our readers.]



The Physician's Most Important Tool

Hint: You probably own several

By Eli Goodman, MD

Imagine a simple tool that helps your physician accurately formulate perhaps 90% of diagnostic considerations, enhances the patient-physician therapeutic relationship, costs nothing extra, has no risk of adverse effects or harm, and the use of which itself is therapeutic. Must be too good to be true.

No! Such a tool actually exists; it always has, and it is just as important now as it ever was. It is the CHAIR!

Medical science and good physicians have always supported the concept that the patient’s history—that is, what he or she tells the physician and what they discuss prior to the physical examination (independent of any tests and procedures)—is the most important entity in medical practice. A good history will deliver the correct diagnosis(es), or array of rational possible diagnoses to consider, 80-90% of the time. It follows, therefore, that anything that facilitates the process of communication known as the medical history must be a super diagnostic tool.

Communication between persons should ideally be face to face, with frequent eye-to-eye contact, unhurried, and at the appropriate physical distance. If the physician is subject to time pressure or detachment, or if he or she stands over the seated or supine patient, the communication process will be compromised. The tool that guarantees that such compromise will not occur is the chair, as the chair essentially forces the physician to listen and communicate properly.

A seated physician will look the patient in the eyes, and will give the impression that he or she is ready and willing to take the time to dialogue properly, and to really try to find out what is going on with the patient. There is now respect and reassurance between two equal discussants, each sharing a common agenda. The patient senses it, and the physician-patient relationship finds itself infinitely enhanced.

This scenario also applies, of course, to subsequent physician-patient discussions that deal with updates, reviews, treatment strategies, etc., after diagnoses are known.

I remind myself to make a big deal about the chair whenever I enter a room to see a patent. I make a little melodrama of it: I fuss with the chair, adjust it, reposition it just so, as I drop myself into it with a sense of repose and anticipation—all to give myself and the patient the signal that I am ready to really listen to and dialogue with the patient. It’s quite a tool, the chair.

Until sooner,

Eli Goodman, MD
Medical Insights Blog

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