Acknowledge Patient Input and Then Proceed


A brilliant piece of wisdom, one that I find myself using in clinic over and over again, comes from dermatologist Michael Greenberg. Michael describes the foundations of improvisational comedy and a simple tool: yes and. He explains that, when doing improv, if a partner says something completely stupid, it is a huge mistake to disagree with them. Instead, you go with it and build upon it.1

Greenberg finds the same approach works well for him with patients. In my experience, he is absolutely right. Patients say and do the darndest things. It is natural for us to disagree with them or to tell them what they are doing is wrong. Instead, he suggests we take a cue from improv and tell patients, “Yes, and…” That way, we can positively acknowledge what the patient offered and then provide our best judgment and advice.

The ultimate example of this may be when patients come to us having (mis)educated themselves on the internet, knowing (incorrectly) what they have and what needs to be done, entirely mistrustful of professional health care providers. 

In those situations, we may want to tell patients how many years of training we have, how much experience we have accumulated, how ludicrous their ideas are, and what the right diagnosis and treatment are.

We would be far better off telling patients, “Yes, and what a relief it is to finally see a patient who I can talk to at my level. You wouldn’t believe how many patients come here who have not taken the time to educate themselves or get even a basic understanding of their condition.” Then I would continue on with my diagnosis and recommended treatment plan.

Improv, clinic, or just talking at the dinner table, giving the other person positive recognition before we say anything else is a good general policy.

Steven R. Feldman, MD, PhD

Chief Medical Editor

Dr Feldman is with the Center for Dermatology Research and the Departments of Dermatology, Pathology, and Public Health Sciences at Wake Forest University School of Medicine in Winston-Salem, NC.


1. Margosian E. Laughing matters. Dermatology World. Published November 1, 2017.{%22issue_id%22:446665,%22view%22:%22articleBrowser%22,%22article_id%22:%222914126%22}. Accessed May 29, 2018.