If you haven’t heard of the “golden minute” you need to read on. There are few tactics that have been shown to be successful in growing a medical/optometric practice that can also be classified as cheap, easy, and having the ability to make you a better clinician. There is actual empirical research on this technique that has demonstrated such positive results. Still need more reason to implement it? How about a few other benefits of the golden minute:

  • Enhanced doctor-patient communication
  • Reduced clinical errors and omissions
  • Reduced probability of legal exposure to malpractice claims

Now that I have you sold on the idea of the golden minute, let’s get into the specific details of what is involved. There are several versions or “flavors” of the golden minute but this is my personal favorite.

Step 1 – Setting the Table

Complete all the tasks need to be completed while in the exam room. This varies greatly depending upon the operations of the clinic but may include record charting, selection of procedure and diagnosis codes, doctor equipment resetting or clean up, etc. Put everything down; you don’t need a pen light, direct scope, 78D lens, or any other equipment for this. If you have paper records put the clip board and pen down as well. You are setting the table for the golden minute and the preparation is critical. The message you are sending with this step is “I am giving you, my patient, 100% of my attention for this discussion.” Failure to properly set the table will attenuate the impact of the golden minute.

Step 2 – Taking Aim

Face the patient straight on. Your body, head, and eyes should be “aimed” directly at your patient. A good way to insure you are positioned properly is the “knee check.” If your knees are not pointing at your patient you are not properly positioned. The objective of this positioning step is to non-verbally communicate to your patient that you are directing your attention entirely toward them.

Step 3 – Summation

Talk to your patient while you succinctly summarize the exam findings and treatment plan including the plan for follow up. Fewer words are better as research has shown that a patient’s ability to take in what a doctor says to them is limited and some cases extremely limited. Use common, everyday language that suits the level of the patient. I have spent a lot of time observing optometrists provide exams for their patients. I can conservatively estimate that over half of the case summaries I have seen contained medical terminology that was beyond the understanding of most patients and did not come with an adequate layman explanation. Finish the explanation by asking if they have any questions about your findings or treatment plans.

Step 4 – Addressing the Questions

Address the comments and questions that follow step 3. If there are several questions take them one at a time. Remember to maintain the proper body positioning as defined in step 2 throughout. The single greatest failure of the golden minute is stopping here. There is a strong indication that the most valuable step comes next but many doctors stop after addressing the patients questions regarding the examination summary. While all the elements of the golden minute are critical, the following steps seem to have to the most significant impact on patients.

Step 5 – Empowering the Patient

Only after all the issues raised during step 4 have been addressed it is time to close the golden minute. This is a simple, yet powerful question that wraps up the encounter with the patient. Exact phrasing depends upon your personal taste and style but my syntax for this question is: “Is there anything that I haven’t gone over that you wanted me to address with you?” I can not tell you how many times the patient has reminded me of a chief complaint that I overlooked because I found something more “important,” in my opinion. A recent personal example was a patient that came in because her eyes were itchy, red and watery. During the course of the comprehensive exam I discovered an epiretinal membrane in the right eye and dry macular degeneration in both eyes. As we continued the additional testing and patient education on her problems I managed to forget what complaint brought this patient in to see me in the first place. Only after asking this question was I able to backtrack and address the allergic conjunctivitis that was concurrently present.

Step 6 – Listen to the additional concerns of the patient and address them promptly or communicate the plan for addressing those issues

OK, I’ll be the first to admit that there is nothing earth shattering in this blog. Most of the steps are common sense and simple application of logical concepts. That said, why are half of the examinations I witness not doing a good job on the final aspect of the encounter? I could speculate on the likely dozens of legitimate reasons why but the easier answer is to just start doing it correctly. Proper use of the golden minute allows for some very interesting situations to occur. For example, it allows the control of the exam to be shared by the doctor and the patient. In many cases these days the exam is dominated by one party or the other, but shared control is a key aspect to a more rewarding examination experience. Additionally, the golden minute will help you become a better doctor by making you more attentive to your patients needs even when their perceptions of “needs” do not align with your perceptions. Finally, the golden minute meets one of the practice management goals of every encounter: make it a positive and memorable experience.

Now find a mirror and practice pointing your knees at some patients!

Maidir te,
John McDaniel, OD, MLHR


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