Patients value how their doctors communicate with them.1 Technology has evolved rapidly in medicine, leading to important advances in healthcare. However, this cultural evolution has created a mismatch between how we are evolved to communicate and how we actually do.2 Today, doctors must interact with technology extensively—computers, monitors, devices, etc.—while also trying to interact with their patients. Since we are evolved to value face-to-face communication and to seek connection with our doctors—with our trusted healers—preventive measures are needed to preserve effective communication in medicine.

If you have been a patient or have visited a healthcare setting recently, you may have noticed that doctors spend surprisingly small amounts of time communicating directly with their patients.3 When they do interact, doctors may be distracted by cell phones, pagers, monitors, computers, devices, and other technologies. Doctors may also appear rushed, hurrying around to get work done and move on to the next thing. For patients receiving care in these environments, it can be frustrating to figure out how to connect with doctors to share, discuss, and plan.

For example, imagine that you are a patient hospitalized for an infection. You do not feel well. You may be confused about what is going on and who is doing what to help you get better. Early in the morning, a doctor enters your room (unannounced), asks a set of questions (many of the same questions that you were asked in the emergency room), gets interrupted by his cell phone (it is his pager), and then scurries out of the room. As the dust settles, you reflect and realize that you have more questions to ask, that you have concerns to share, and that you are unclear about the steps ahead. Perhaps more importantly, you do not feel connected to your doctor.

What could be done about this?

Evolutionary mismatch provides a valuable lens for viewing this challenge. Cultural evolution created technologically-advanced contexts that make it difficult for doctors to communicate with patients in manners concordant with our evolved, ancestrally-familiar modes of communication (face-to-face, without extreme time constraints, etc.). Given these known modern constraints, one preventive approach to preserving effective communication is a mindfulness practice: behavioral awareness.

Return to the previous scenario, and imagine that you are the doctor rounding on the patient hospitalized for an infection. As this doctor, your encounter with the patient can be divided into five domains of behavior: (1) Hi (Entering); (2) Familiarize (Identifying); (3) Interact (Connecting); (4) Voice (Discussing); and, (5) Exit (Concluding). Now, envision progressing through each domain as you review the following communication checklist (within each domain, suggested behaviors, along with tools and techniques to do them, are included as illustrative examples):

The Hi-FIVE Communication Checklist (PDF here)This “domains of behavior” framework could be adapted to various clinical environments to match key behaviors to different contexts.

If doctors utilized this type of checklist as a mindfulness practice to support connecting and communicating with their patients, they might find that it helps them navigate the mismatches of today’s healthcare environments. Ultimately, perhaps the process of creating a customized checklist using a behavioral-awareness approach might be a personalized mindfulness activity that any doctor could do to improve his or her communication skills and preserve what both doctors and their patients value: effective, empathic communication.

Read the full Evolutionary Mismatch series:

  1. Introduction: Evolutionary Mismatch and What To Do About It by David Sloan Wilson
  2. Functional Frivolity: The Evolution and Development of the Human Brain Through Play by Aaron Blaisdell
  3. A Mother’s Mismatch: Why Cancer Has Deep Evolutionary Roots by Amy M. Boddy
  4. It’s Time To See the Light (Another Example of Evolutionary Mismatch) by Dan Pardi
  5. Generating Testable Hypotheses of Evolutionary Mismatch by Sudhindra Rao
  6. (Mis-) Communication in Medicine: A Preventive Way for Doctors to Preserve Effective Communication in Technologically-Evolved Healthcare Environments by Brent C. Pottenger
  7. The Darwinian Causes of Mental Illness by Eirik Garnas
  8. Is Cancer a Disease of Civilization? by Athena Aktipis
  9. The Potential Evolutionary Mismatches of Germicidal Ambient Lighting by Marcel Harmon
  10. Do We Sleep Better Than Our Ancestors? How Natural Selection and Modern Life Have Shaped Human Sleep by Charles Nunn and David Samson
  11. The Future of the Ancestral Health Movement by Hamilton M. Stapell
  12. Humans: Smart Enough to Create Processed Foods, Daft Enough to Eat Them by Ian Spreadbury
  13. Mismatch Between Our Biologically Evolved Educative Instincts and Culturally Evolved Schools by Peter Gray
  14. How to Eliminate Going to the Dentist by John Sorrentino
  15. Public Health and Evolutionary Mismatch: The Tragedy of Unnecessary Suffering and Death by George Diggs
  16. Is Shame a Bug or a Feature? An Applied Evolutionary Approach by Nando Pelusi
  17. The “Benefits,” Risks, and Costs of Routine Infant Circumcision by Stephanie Welch
  18. An Evolutionary Perspective on the Real Problem with Increased Screen Time by Glenn Geher
  19. Did Paleolithic People Suffer From Kidney Disease? by Lynda Frassetto
  20. The Physical Activity Mismatch: Can Evolutionary Perspectives Inform Exercise Recommendations? by James Steele


  1. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. Ochsner J. 2010 Spring;10(1):38-43.
  2. Temple University. “Let’s Face It, Man is Not Made to Communicate Electronically.” ScienceDaily, 30 July 2001. www.sciencedaily.com/releases/2001/07/010730081336.htm
  3. Becker G, Kempf DE, Xander CJ, Momm F, Olschewski M, Blum HE. Four Minutes for a Patient, Twenty Seconds for a Relative: An Observational Study at a University Hospital. BMC Health Serv Res. 2010 Apr 9;10:94.

Header image by Direct Relief via Flickr

Published On: March 20, 2019

Brent C. Pottenger

Brent C. Pottenger

Brent C. Pottenger, MD, MHA is a physician at Johns Hopkins. At the University of California, Davis, he earned a Bachelor of Science degree in Physiology and Financial Management for Healthcare, with a minor in Contemporary Leadership. He completed a Master of Health Administration graduate degree at University of Southern California. He graduated from the Johns Hopkins University School of Medicine and received The Samuel Novey Prize in Psychological Medicine. Then, he worked as a Healthcare Systems Leadership Fellow in the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.


  • Roy Pottenger says:

    Hi Brent,
    I read your article and agree. My Orthopedic group was our area the first to instal an electronic medical records system early 2000’s. We did not have scribes( which I believe is below the standard of care);; but, we had to care fore the patient and enter the chart EMR before seeing my next patient. I soon learned that it was a great misconnect with my patient, to type our visit while trying to treat a patient hurting and in need. I discovered Dragon, and this allowed me to dictate in front of my patient, using their words and often being corrected by them about their story.
    The early Edison was much to be desired. But, with practice it became a good way for me to share the visit with my patient. At the end, I would print out their visit record and they would have their record to take, including their H And P, Exam, labs, X-ray interpretation and treatment plan and Rx.
    As a patient 15 years later, I still am disappointed that many physicians I see, don’t make eye contact while asking your History, chief complaint, etc. They are focused on typing the office visit to make certain all the bullet points are noted, so they can upgrade the the coding to maximize their reimbursement by insurance.they bill for a complex visit, but not only do you miss face tie, often you miss the laying on of their hand for a complete exam.!
    Recently, We went to the Level 2 Trauma ER for care of my wife’s illness. After 9 hrs in the waiting room, we did not get a room, did not see aMD or PA. They drew blood work( which we did not get results,and we finally left to home, treating ourselves and very frustrated with ModernMedicine.
    Your contribution to Medicine, Brent, is on target. I am proud of you.
    I would enjoy a follow up response.
    Roy. N. Pottenger, M.D,, M.S., F.A.C.S.

  • Lloyd Hudson says:

    I am going to share this with my peer group.
    My scope of practice is in both general and psychological medicine.
    Much discussion and challenges centre on issues of engagement.
    My practice involves a shared writing up to the consultation with an agreed management plan which is then printed out for the patient.
    Patients tend to enjoy the editing process as well as pointing out where I have got things wrong.
    As an older doctor not under significant time constraints this enables better outcomes.
    Unfortunately my younger colleagues do not have this opportunity.
    While person-centred Medicine is regarded as best practice it seems a fading ideal.

    From the antipodes
    Dr Lloyd

    PS found this site after chasing up Melvin Konner and Rene Girard

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.