Ninety seconds for the patient

Nov 21, 2022

by Ronald Epstein, MD

So often we listen to respond, not to understand, as Steven Covey noted in his best-selling book, “Seven Habits of Highly Effective People.” 1 As doctors, we are trained to respond; we are doers, we get to the point, take charge and fix. However, people come to see us with other hopes for consultation. They want to feel understood. While we’re trained to “take” a history and provide recommendations, often we forget the most important thing – patients want to know that someone is listening.

Communication skills courses for medical students and practicing physicians, including those that have I developed over several decades, emphasize what to say, but offer little instruction on how to listen. This came to a head for me when I was particularly distressed and burned out as our health organization was launching a new electronic health record system. I thought that things were going okay until a long-time patient commented, while he really liked me as a doctor, since getting the new computer system, he felt I wasn’t really there in the way that I had been in the past. Devastated, I knew it was true. Too often, the screen would hijack my attention and I wasn’t listening.

Overwhelmed with the seeming impossibility of the task – to listen deeply to understand each patient’s unique experience of illness and alsorespond to computer-generated alerts and check-boxes – I came upon a first step, a small one perhaps, but a start. An exercise in listening to understand, an exercise in presence. I’d invite you to try it. It seems very simple, but as I discovered, it’s not always that easy. Here it is:

For the first ninety seconds of a patient visit, listen to understand. Don’t log on to the EHR, don’t look at the screen, don’t take notes, and don’t provide advice or recommendations. Just listen, ask questions to clarify your understanding; and, after ninety seconds, move on.

Try it for a month, perhaps starting with one patient per day. Increase to two, then more, but not too quickly. Note what’s easy and comfortable to listen to and what topics invite distraction or mind-wandering.

Teachers of meditation often emphasize that being mindful is not a state, but rather a process of bringing back the wandering mind (to paraphrase William James),2 over and over again so that, ultimately, we’re more attentive and present. For those ninety seconds, your listening to the patient is a kind of meditation. It’s not just about you, but about you-with-the-other, a relational practice.

Initially, it felt like a radical act of civil disobedience. It didn’t take much time to discover that taking those ninety seconds didn’t extend my day; I got home at the same time. I was happier. I was doing what I aspired to do. Burnout receded into the background. I didn’t have to ask patients to repeat themselves because I was too busy preparing to respond. My chart notes were more concise and accurate. I felt better able to navigate the chaos of clinical practice, and less likely to quit.

Since then, I have made it a habit. Of course, sometimes I forget.  So, be patient with yourself.  When your attention lapses, be curious about why something seemingly simple can also be difficult. Congratulate yourself for noticing that your mind was wandering and bringing your attention back to the most important thing.

1.  Covey SR. The Seven Habits of Highly Effective People. New York: Fireside; 1993.

2.  James W. The principles of psychology. Cambridge, MA: Harvard University Press; 1981.



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