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September 8, 1993

'Windows of Opportunity' to Address Patients' Concerns: Too Small and Too Few?

JAMA. 1993;270(10):1195. doi:10.1001/jama.1993.03510100045015

To the Editor.  —The Brief Report by Drs Branch and Malik1 entitled "Using 'Windows of Opportunities' in Brief Interviews to Understand Patients' Concerns" is a timely article. It describes videotaped patient interviews by five seasoned clinicians. Although the tone is upbeat, the article is a sad testament to medical training in that some of the best and brightest clinicians from a renowned institution dealt with patients' psychosocial issues in only 20% of interviews.Branch and Malik observe that the clinicians were not systematic in their interviewing skills. Every physician-patient encounter has the opportunity to be therapeutic as well as diagnostic. It is not enough to apply open-ended questions as to "what is going on?" and conclude with empathic closures. This is akin to addressing an audience with an introduction and conclusion while omitting the body.In their book The Fifteen Minute Hour: Applied Psychotherapy for the Primary Care Physician