Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Use the Janus principle in your medical practice

Neil Baum, MD
Physician
September 15, 2012
Share
Tweet
Share

Janus is the Roman god of doors and gateways but also the god of beginnings.  Interestingly, good beginnings and required for good endings.  The Temple of Janus had doors facing east and west, which allowed illumination of the temple at the beginning and the end of the day.  Most statues of Janus show him with two faces facing opposite directions.

The Janus principle in your medical practice is the idea of creating a favorable beginning of the doctor-patient interaction which culminates in a favorable ending.

How to get off to a good a good beginning?

It all starts with the first impression.  There’s a world of difference if the doctor enters the room and launches into medical questions versus the doctor who uses the first few seconds to talk about some non-medical topic such as the patient’s family, work, or last vacation.  This information can be obtained by keeping social progress notes on the written chart or on the first screen of the EMR.  Now the doctor demonstrates his interest in the patient and not an organ system, a diagnosis, or lab or X-ray report.  You can be sure that this registers in a positive way with your patient and well worth the few seconds it takes to demonstrate caring for the whole patient.

The Janus close

Closing the office visit is the natural conclusion of every patient interaction.  Every patient visit needs to terminate with a successful close.  You will know you have closed successfully when the patient agrees to your advice, promises to take the medication, obtain the studies you suggest, or accept the surgical procedure you recommended.  Most patients leave without any physical evidence of their commitment to the doctor.  The close is intangible but you can recognize the signs of agreement or rejection very easily.

The Janus principle focuses less on rote formulas such as ending each visit with, “Is there anything else I can answer for you today?”  It does take into consideration the general tone and feel of the conversation with care and attention to begin well and to close well.  If it is done well, you have buy-in from the patient and a greater likelihood of enhanced compliance from the patient and improvement in patient outcomes.  You increase the buy-in if you learn to listen to what the patient says and pay attention to both verbal and non-verbal clues, which provide you with the feedback of the success of your close.

Doctors have the luxury of asking probing questions.  I am always amazed at the depth of questions that I am allowed to ask in areas that no other person could ask another individual.  After meeting a patient for the first time, I am able to ask about their personal life, their sex life, and their bowel habits.  No other professional could possibly accomplish this except a physician.  In order to be successful at asking probing, we must appear genuine and that we are caring and avoid making the patient defensive.  The best probing questions are open ended and not answered by mere yes and no questions.  It is a far better question to ask how the chief complaint is impacting the patient’s quality of life rather than is the pain mild, moderate or severe.

Next make sure to validate or acknowledge probing question that you ask.  This can be a head nod or use the echo technique of restating the last phrase of the patient’s response to your probing question.  For example, if I ask a man about his ability to engage in sexual intimacy with his partner and he responds that the problem is upsetting his partner.  I would counter with “How is this upsetting your partner?”  This clearly lets the patient know you have heard his response and you are paying attention to the discussion.

Psychologists point out that 70% of the population respond better to suggestions than to warnings.  Nearly 80% of patients’ buy ins are made emotionally and then they use logic to defend their behaviors.  You might approach the close by asking the patient what they feel about the lifestyle changes you might be suggesting they make.  If the patient agrees to the plan of action, you can ask for agreed upon goals.  Perhaps you can ask the patient to join the YMCA or a local gym and commit to an exercise program with the goal of losing two pounds in the next month or before their next visit.

This brings the Janus close to a successful conclusion.  You use the probing questions, provided the patient with motivation, and then receive their commitment and buy-in resulting in improved compliance.

Bottom Line:  We have less time to spend with patients because of the greater volume of patients that most of us are going to be seeing in the near future.  We will have to be experts at communication in order connect with our patients which begins with great openings and positive closings. The Janus close starts with a good beginning and then has a happy ending.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MD, or on Facebook and Twitter.

Prev

These are the reasons why nurse practitioners are special

September 15, 2012 Kevin 13
…
Next

Useful design flaws explain some hemoglobin disorders

September 15, 2012 Kevin 1
…

ADVERTISEMENT

Tagged as: Patients, Primary Care, Specialist

Post navigation

< Previous Post
These are the reasons why nurse practitioners are special
Next Post >
Useful design flaws explain some hemoglobin disorders

ADVERTISEMENT

More by Neil Baum, MD

  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How the 10th Apple Effect is stealing your joy in medicine

    Neil Baum, MD

More in Physician

  • Harassment and overreach are driving physicians to quit

    Olumuyiwa Bamgbade, MD
  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • Life’s detours may be blessings in disguise

    Osmund Agbo, MD
  • Inside the heart of internal medicine: Why we stay

    Ryan Nadelson, MD
  • The quiet grief behind hospital walls

    Aaron Grubner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why regular exercise is the best prescription for lifelong health

      George F. Smith, MD | Conditions
    • When the weight won’t budge: the hidden physiology of grief, stress, and set point

      Sarah White, APRN | Conditions
    • Why starting with why can transform your medical practice

      Neil Baum, MD | Physician
    • Why your most heroic act might be in a department meeting [PODCAST]

      The Podcast by KevinMD | Podcast
    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Use the Janus principle in your medical practice
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...