First 5 Minutes® - phaware® interview 530
Jul 23, 2025
In this episode, Drs. Victor Test, Deborah Levine and Rodolfo Estrada discuss CHEST’s First 5 Minutes® program, which helps medical professionals build the skills that lead to a positive relationship with patients from the get-go. The goal is to improve patient care, shorten time to diagnosis for complex or rare diseases like pulmonary hypertension, and increase patient compliance and buy-in to their treatment plan.
Victor
Test, MD, FCCP:
I'm Dr. Victor Test, Chief of Pulmonary Medicine and Critical Care
at Texas Tech University in Lubbock, Texas and Director of the
Pulmonary Vascular program.
Deborah
Levine, MS, MD, FCCP:
Hi, I am Debbie Levine. I'm a lung transplant and PH doctor and I'm
working at Stanford University.
Rodolfo
Estrada, MD, FCCP:
Hi, I am Rodolfo Estrada. I'm a UT Health San Antonio pulmonologist
and working in pulmonary hypertension, as well. Today, we want to
share a little bit about the First 5 Minutes initiative from CHEST,
which talks about how do we approach patients in the first five
minutes to gather the most amount of information, create trust, and
build up empathy to better care for patients.
Victor
Test, MD, FCCP:
The First 5 Minutes program was developed in response to our
recognition at CHEST about the difficulty that had developed during
the period of the COVID pandemic with trust between patients and
healthcare professionals, and particularly physicians. As you know,
during that time we were all particularly challenged because of
lots of information in the media and doubt and fear with patients.
The difficulties we faced in ICU care of critically ill patients
with isolation and the difficulty that families had with that. So
in response to that, we developed something called The Listening
Tour where in five different cities of the US, including San
Antonio and San Francisco and Atlanta and Chicago, we went out and
we recruited patients and we spoke to them about the challenges
they had faced with their chronic lung diseases. They ranged from
asthma to COPD to pulmonary fibrosis to pulmonary hypertension, and
how their patient journey was impacted by their interactions.
What we learned was that there was a significant breakdown in
trust. As a physician, usually I go into a room assuming that I
have trust. What we really realized is that physicians have to
build that trust and develop that trust. It isn't just given to us
as an anointment because we're a physician and we're there to try
to help. So we developed at CHEST this program called the First 5
Minutes. The concept of it is that physicians and healthcare
providers need to develop a rapid rapport and understanding of the
patient and develop this trust with active listening, empathetic
listening and direct feedback with emotional support while
incorporating the patient into the decision-making
process.
Deborah
Levine, MS, MD, FCCP:
I think really what the First 5 Minutes is an approach to how we as
physicians can interact with our patients when we either don't know
them or do know them, to kind of build a bridge of trust but also
learn to respect each other in terms of being able to understand
the best ways to communicate and also understand. I think patient
understanding is a big part of it.
Rodolfo
Estrada, MD, FCCP:
The beautiful thing about the First 5 Minutes is that you can use
it for new patients and follow up patients because it caters to
whatever the patient thinks is most important for them for that
visit. Sometimes, we pre-chart those patients and have an idea of
what we want to talk about, but the patient has new findings and
new developments happening. If you take those first five minutes
and you take a moment to really elicit that out, most of the times
the patient will bring it up but won't be the first thing that they
bring up.
One of the tools that the First 5 Minute initiative has is that you
ask, “What else? “Then you ask again, “What else?” Then you ask
again, “What else?” Maybe by the third “What else,” the real
conversation comes on, and then you can develop the rest of the
time talking about it and still do your clinical part that you have
to do, but in alignment to what's important for the patient for
that specific visit. If it's emergent, they'll bring it up quicker
than the other ones, but otherwise I think they'll still be able to
bring it up.
Victor
Test, MD, FCCP:
What we're trying to do is to push this program forward so that we
spread it out to physicians at all levels of training as well as
post-training, so that it permeates throughout the US healthcare
system. We'd really like for it to eventually be part of every
training program and post-training program so that our physicians
can breach that divide between patients and physicians. It really
doesn't have to be physicians, it could be physicians assistants,
nurse practitioners, nursing, medical assistants. Anyone can be
taught these skills. Sometimes, there's a concern by people when
they hear about this, the say, “Well, that's going to take a lot
more time.” In fact, studies show that empathetic listening and
patient-centered interviews actually take less time and they make
the healthcare more efficient. It actually has a win-win solution
for most physicians if they're able to use these skills and it
helps the patient and develops trust, we believe. This tool set and
this educational program can make a big difference for our
pulmonary critical care physicians.
Ultimately, the goal here is to improve patient care and to
incorporate them into decision making. We believe and we hope that
that would decrease time to diagnosis for difficult to diagnose or
more rare disorders. Certainly, we wanted to improve healthcare for
patients so that we can help identify the obstacles that they face,
and improve their compliance and their buy-in to whatever program
we develop for them for their care. It aligns the patient and the
physician so that they can each achieve the goals that the patient
and the physician have, and put them in parallel rather than
disparate pathways.
Deborah
Levine, MS, MD, FCCP:
The idea that we as a community, I'm talking all physicians whether
it be PH or anything else, we are limited often in time. If you are
in a busy pulmonary clinic where you're seeing 30 patients in the
morning and 30 patients in the afternoon, you may have some type of
preconceived notions or preconceived ideas about what this patient
has. So leading that patient, you may be leading him or her to say
what you believe they have. This way, I think it is more efficient,
because you can then say, "Hey, listen to the story.” Take the five
minutes and listen to the story. It may not be asthma and it may
not be COPD, which is what many of our patients are diagnosed with
instead of whatever they have. I think this can help that bridge to
understanding what the patient has, but also it can do it in a way
that also kills two birds with one stone. You maybe get a more
efficient trajectory in terms of getting a diagnosis, but also you
make them feel so much more comfortable.
Rodolfo
Estrada, MD, FCCP:
I think that's something that's important within the rare disease
space with PH being one of them, is that, as humans, we're
prediction machines. When we see someone with shortness of breath,
we're going to go and think about what's the most likely diagnosis
from what we've seen in the past. In the rare disease space, that
becomes challenging, because then we have to pause. Having that
pause initially when you're first going to see the patient and
checking if your biases, if your assumptions, are correct. That can
be taught and doesn't need a lot of time. So a nurse that sees a
patient before the provider goes into the room can have that same
approach of pausing, and making sure that what we're seeing and
what the patient is saying are congruent things.
Victor
Test, MD, FCCP:
One of the things that has been observed in medical interviews is
that patients often are interrupted quite frequently by healthcare
providers to try to facilitate their story. When in fact, when
patients are left to tell their own story they often give a more
complete and thorough story than we as healthcare providers would
like to ask.
So the PEARLS is an acronym to remind us of important points in
interacting with the patient. They range from personal to support,
and empathy, acknowledgement. When you use those in a patient
interview, you don't have to use them all in every interview. In
fact, if you did, you probably would defeat the purpose of them.
But to use those different points to help you to connect with the
patient and help each other understand the healthcare that they're
receiving is actually a team between them, their family and the
healthcare providers that they're seeing.
Deborah
Levine, MS, MD, FCCP:
I learn a lot more about patients, their families, and their life.
There's no question that that comes organically. Empathy isn't
something you have to think about, it just happens, because if you
hear these patient stories, if you hear their families talking
about them and their past, it's there. You automatically become
very involved and included into their life. That's what I think it
does. It makes that easier to make it more than just the
patient-physician relationship. It makes you feel empathetic. I
think that's a big deal. I don't think you have to do it. It
happens on its own with this process.
Rodolfo
Estrada, MD, FCCP:
Another aspect I think is important is that the patients when they
show up to a provider, they have an expectation of something from
that visit. Sometimes, the provider may give medications, but with
the First 5 Minutes, you can also give them a space for the patient
to actually share their journey and share their experience. The
patient visit becomes complete when the patient is fulfilled. I
think the providers will be more comfortable at times not
prescribing medication because their role has been fulfilled
through that visit. I think that will actually allow for these
patients with pulmonary hypertension to be recognized earlier on,
because the symptoms are pretty characteristic once their story is
allowed to come to life. I think that's what the First 5 Minutes
allow to do.
Victor
Test, MD, FCCP:
We really want to develop this program so that it improves patient
communication and trust so that we shorten this time to diagnosis.
When I first began working in pulmonary hypertension, the average
time to diagnosis was two and a half years from the onset of
symptoms. In registries that are published after that, despite the
increasing technology and awareness of the disease that time has
actually increased into nearly three years. We need to actively
work to change that from a pulmonary hypertension standpoint. But
the First 5 Minutes is not just for pulmonary hypertension, it's
for all lung diseases or really any disease. We want to shorten the
time to diagnosis of complex lung diseases.
Deborah
Levine, MS, MD, FCCP:
Where I think it's going to help the most is, obviously, with PH
doctors or whatever the specialty is, asthma doctors or something.
But actually with more generalized care either in the ER or the
primary doc or even a community physician that is not in a
specialized practice. I think that's where it starts and that's
where a lot of the delay is, because patients come to us on
inhalers that don't need inhalers because they don't have asthma.
My thought is yes, I think it will help all of our teams. I think
even more than that, it will help us if we can get this type of
practice out to more of the general community. Even in the ER, you
can take five minutes and get a good history, because maybe this is
not what they have and maybe this is.
Rodolfo
Estrada, MD, FCCP:
What I think about the First 5 Minutes in the pulmonary
hypertension space is that these patients go through a lot for a
very long time. It's not just the patient, but their community,
their work, their families. The First 5 minutes allows the provider
and the priority system to understand that dynamic a little bit
better. It's not only the outcome of being able to walk more or
mortality, it's what is the day-to-day looking like and how do we
make that day-to-day better with interventions that we have
available? Sometimes, those interventions are listening and being
part of the journey with our patients, that conversation of
empathy. Empathy is something that the provider and the system will
feel once you start getting into a personal note with these
patients that our system sometimes doesn't allow us as much. This
is a tool to really bring that story to life and bring it into the
space of conversation.
Thank you for listening. My name is Rodolfo Estrada…
Victor
Test, MD, FCCP:
I'm Dr. Victor Test…
Deborah
Levine, MS, MD, FCCP:
I'm Dr. Debbie Levine, and we are aware that our patients are
rare.
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