Of the things I face each day perhaps the most remarkable is the exam room door. It’s the gateway to what I do. As a conduit to the patient, it punctuates the beginning and end of the patient encounter.
The ultimate moment of clinical focus
There’s a process that happens during the moments before I enter. There’s something of a ritual or process that plays out in my head. It’s a confrontation of sorts. It’s where I rehearse conversations and weigh options in the most focused way. It’s where I collect myself when I’m way behind and anything but together. It’s during these moments that I figure it out.
There’s no better palate for intentional, clinical thinking than the quiet, constrained 6-inch space between you and an exam room door. And in an environment of always-on information flow this stark, heavy piece of wood has a way of making me stop. The door reminds me that something’s about to happen.
In medicine we celebrate unknowns. And as doctors we are defined by our clinical encounters and our management of the unknowns brought by the patient. This fragmentary moment of quiet and pause epitomizes the nature of what’s about to happen.
The person on the other side
If it’s not a big deal for you it is for the person on the other side. They’ve been thinking about you. They’ve wondered what you will be like. They’ve pictured you and imagined just how you might be. As they wait they replay their story and wonder how you’ll listen and respond. They listen to the sounds outside and wonder when it’s going to start.
What they see and what they feel begins the moment you open the door.
How I connect from first eye-contact shapes how effective I’ll be. In my world it’s about the child and what she thinks. Otherwise a toddler will never trust and a teen will never talk. Like any other relationship be it business or romance, the opening moments after crossing the clinical transom are the most critical.
Burden or opportunity
My perspective on the door has changed over time.
- As a young resident the door represented a burden. At best what sat behind was a curiosity to satisfy a selfish intellectual drive.
- When I had to pay the bills, doors represented opportunity. For me.
- With maturity each door and what stood beyond came to represent the opportunity to see beyond myself.
Doctors have been walking through doors for centuries. But the spaces in which we care are evolving. There are new media through which we can connect with patients. Despite how we connect, I suspect that there will always be the door in some iteration.
Or that moment before the encounter.