A worsening doctor-patient communication problem

Back in Medical school, we learned that doctors are quick to interrupt patients at the very start of the clinical encounter — my colleagues and I all committed to doing better. 

 Interestingly, that study from the 1980s informed decades of budding physicians that we cut off patients 17-23 seconds after asking them our initial question. 

Now, I work with extremely complex patients — many with comorbid medical, psychiatric and addictions issues — and they can be difficult to get to an appointment. I’m very motivated to accomplish as much as possible during the 30 minutes I have with my patients. I’ve also worked in busy, bread-and-butter family medicine clinics with a brisk pace. 

Intuitively, we doctors think it’s more efficient for us to control the dialogue of the encounter, rather than the patient. We’re wrong.

Despite three decades of communication training, physicians nowadays interrupt patients after only 11 seconds while giving their initial history, according to Ospina et al (2018). We’ve gotten worse despite ourselves.

Listening to patients

We worry that if we don’t manage the conversation patients will go on and on and on when, in actuality, if left to speak the average patient will complete their sharing within 90 seconds, sharing their primary concern after about 29 seconds. 

In my experience, when we don’t allow patients to tell their story, the most important concern may not come out because patients rarely share this concern first; they like to get warmed up with a less significant issue. 

As a result, our interruption of our patients complicates diagnosis in over 50% of cases. It’s hard to account for the time lost when patients are unable to disclose their main concern or a complete history because you and I are too busy talking. 

Effective and efficient client history

So when I’m feeling rushed, I need to remember that I can economize my tasks, but interrupting patients right off the bat is only going to get me more behind.

Bottom line: Start your clinical encounter with an open-ended question like “What brings you in today?” Then, give your patients a full 90 seconds to talk without interruption. 

 

Reference

Singh Ospina, N. et al (2018). Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters, Journal of General Internal Medicine DOI: 10.1007/s11606-018-4540-5

 

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