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Most doctors don’t give patients enough time to explain the reason for their visit, study finds

REUTERS/Jim Bourg
When doctors don’t understand their patient’s concerns, they can’t engage in patient-centered care.

Do you feel like your doctor doesn’t listen to you?

Well, you may be right.

Doctors give patients an average of only about 11 seconds to describe their symptoms or reasons for seeking medical care before interrupting them, according to a study published this month in the Journal of General Internal Medicine.

The study also found that only about one in three doctors gives their patients any opportunity to explain their medical concerns at the start of a consultation.

“If done respectfully and with the patient’s best interest in mind, interruptions to the patient’s discourse may clarify or focus the conversation, and thus benefit patients,” says Naykky Singh Ospina, the study’s lead author and an endocrinologist at the Mayo Clinic and the University of Florida, in a released statement. “Yet, it seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at the early stage in the encounter.”

“Our results suggest that we are far from achieving patient-centered care,” she adds.

‘Inherently therapeutic’

As Singh Ospina and her colleagues point out in the introduction section of their study, “the medical interview is a pillar of medicine. It allows patients and clinicians to build a relationship.”

“Ideally, this process is inherently therapeutic,” they add, “allowing the clinician to convey compassion, and be responsive to the needs of each patient.”

Previous studies that have looked at the communication skills of doctors during patient visits (studies that date back to 1984) found that large majorities of doctors interrupted their patients. They waited slightly longer than in the current study, however, to do so — between 16.5 and 23 seconds, on average.

One of those studies also reported that the failure of doctors to let patients explain the purpose of their visit was associated with a significant reduction in the doctors’ understanding of the patient’s medical concerns.

When doctors don’t understand their patient’s concerns, they can’t engage in patient-centered care, which, as Singh Ospina and her colleagues point out, “is considered an important dimension of health care quality.”

Patient-centered care “describes a culture where a partnership among practitioners, patients, and their families is established to ensure medical decisions respect patients’ wants, needs, and preferences, and that patients have the education and support they require to make medical decisions and participate in their own care,” they explain.

Study details

For the current study, Singh Ospina and her colleagues analyzed randomly selected video and audio tapes of conversations recorded during 112 patient-doctor consultations at general-practice clinics in Minnesota and Wisconsin and at the Mayo Clinic in Rochester. The consultations were initially recorded so that they could be used to train new doctors.

The researchers took note of whether the doctors encouraged the patients to set the agenda for the consultation by asking such questions as “How are you?” or “What can I do for you?” They also looked at whether and how quickly patients were interrupted when answering those types of questions.

The study found that patients were able to put their agenda first — to start the consultation by explaining why they had come to see the doctor — in only about a third of the visits. Yet, even when patients were given the chance to talk, they were interrupted by the doctors seven out of 10 times — and after a median of only 11 seconds.  (The range was three seconds to 234 seconds.)

Furthermore, when the doctors interrupted their patients, it usually wasn’t with an open-ended comment or question, such as “That must be painful” or “How often does that symptom occur?” Instead, in 69 percent of the cases, it was with a close-ended question that required the patient to simply answer “yes” or “no.”

When patients were allowed to complete their opening description of their symptoms and other medical concerns, however, they tended to so quickly — within about six seconds, on average.

Primary care doctors, such as general practitioners, family practitioners and internists, tended to give their patients more time to talk about their concerns than specialists. They also interrupted less.

Specialists may be more abrupt with patients because they already know the reason why a patient has been referred to them, says Singh Ospina.

“However, even in a specialty visit concerning a specific matter, it is invaluable to understand why the patients think they are at the appointment and what specific concerns they have related to the condition or its management,” she adds.

What you can do

Singh Ospina and her co-authors cite several possible reasons why so many doctors are so abrupt with their patients. They point to the demands of filling out electronic health records, the pressure from health insurers to keep patient visits short and the increasing number of items that physicians are mandated to do during each patient consultation.

The growing problem of physician burnout is another possible explanation, they add.

All of these factors “clutter, interrupt, and disrupt the clinical encounter,” the researchers write.

So what can patients do to keep their doctor’s appointments on track with their needs?  Prepare for each visit. Here are a few tips from the National Institute of Aging. Although aimed at older adults, these tips are applicable to people of all ages:

List and Prioritize Your Concerns. Make a list of what you want to discuss. For example, do you have a new symptom you want to ask the doctor about? Do you want to get a flu shot? Are you concerned about how a treatment is affecting your daily life? If you have more than a few items to discuss, put them in order and ask about the most important ones first. Don’t put off the things that are really on your mind until the end of your appointment — bring them up right away!

Plan to Update the Doctor. Let your doctor know what has happened in your life since your last visit. If you have been treated in the emergency room or by a specialist, tell the doctor right away. Mention any changes you have noticed in your appetite, weight, sleep, or energy level. Also tell the doctor about any recent changes in any medications you take or the effects they have had on you.

Take information with You. Some doctors suggest you put all your prescription drugs, over-the-counter medicines, vitamins, and herbal remedies or supplements in a bag and bring them with you. Others recommend you bring a list of everything you take and the dose. You should also take your insurance cards, names and phone numbers of other doctors you see, and your medical records if the doctor doesn’t already have them.

Oh — and if the doctor interrupts you while you’re explaining the reason for your visit, tell him or her you’re not quite done yet and you would appreciate it if you could have a few more seconds to complete what you want to say.

FMI: The new study can be read in full on the website of the Journal of General Internal Medicine. For more tips on how to prepare for a visit to a doctor, go to the National Institute of Aging’s website.

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