Fast-Food Rule: The Golden Rule of Communication

Whenever you’re speaking with an upset patient, start by acknowledging their feelings before offering any comments, explanations, or advice. In medicine, we’re trained to diagnose, treat, fix, and move on. We’re surrounded by knowledge, tools, and technology—so we naturally focus on efficiency. How many patients can we see in clinic? How quickly can we round? How many surgeries can we perform in a day?

But patients are not numbers. They are people with fears, stories, hopes, and worries.

I recently discussed this idea with Dr. Mel Thacker, who introduced me to the concept of the “supercommunicator”. Her belief is simple but powerful: the secret to exceptional patient care lies not just in medical expertise, but in emotional attunement. It’s the ability to listen to a patient’s story and reflect back the emotions you hear—anger, sadness, frustration, confusion, hope. Most patients aren’t necessarily seeking a “diagnosis” first. They’re seeking an explanation, a sense of being understood.

This is where the “Fast-Food Rule” comes in.

As pediatrician Dr. Harvey Karp explains, fast-food restaurants actually model one communication skill remarkably well: when you place your order, the cashier repeats it back to you. They do this because clarity and confirmation matter. And, importantly, the hungriest person—the customer—always speaks first.

In health care, the patient is the “hungriest” person: the one most in need, the one with the strongest emotions. Our job is to let them speak first and then to reflect back what we’ve heard with sincerity. Only then do we move on to guidance or advice.

Agitated patients make poor listeners. But once their emotions are released and validated, their minds open. The next time a patient tells you how much pain they’re in, resist the reflex to jump immediately into diagnosis mode. Instead try:

• “Wow, that sounds incredibly difficult.”
• “No wonder you’re feeling upset.”
• “I’m sorry you’re going through this—tell me more.”

Respect is the foundation of any strong relationship, and this simple shift can transform the physician-patient dynamic. Try the Fast-Food Rule, and see how much more trust, clarity, and connection it brings to your care.

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