A doctor’s appointment can make patients feel like their concerns are not being heard or even noticed, and their stories rushed — and it’s no surprise.
Only a third of doctors ask patients to share the reason for their visit, and when they do, they interrupt after about 11 seconds, a recent study found.
The findings are consistent with previous similar research and suggest the medical community is “far from achieving patient-centered care,” wrote the authors of the paper, published this month in the Journal of General Internal Medicine.
“The results of our study are worrisome,” lead author Dr. Naykky Singh Ospina, an assistant professor of medicine at the University of Florida, told TODAY. “They suggest that physicians interrupt patients extremely quickly when they are expressing their concerns.”
The findings are based on an analysis of 112 doctor visits that were recorded between 2008 and 2015 in general practices in Minnesota and Wisconsin, and at the Mayo Clinic and its affiliated clinics.
Only 36 percent of doctors in the study asked patients questions such as, “What can I do for you today?” or “What is your main concern?” Primary care physicians asked more often — almost half of the time — than specialists, who did so only 20 percent of the time. That could be because specialists are more focused on a specific problem, such as the reason for the referral, the study authors noted.
When doctors did invite patients to explain their reasons for the appointment, they interrupted after a median of 11 seconds.
Doctors' view
Several physicians told TODAY they were not surprised by the findings, but noted this is not how doctors are trained.
“One of the first tenets we teach our students is to ask open-ended questions and let the patient speak uninterrupted,” said NBC News medical contributor Dr. Natalie Azar, who is an instructor in the practice of medicine course at the New York University School of Medicine.
“A lot of important information will be missed if the encounter is rushed and that can adversely affect care ... It would be like solving a puzzle without all the pieces.”
“So what is wrong with us? Speaking from my own experience, I can tell you that there's nothing a physician would like to do more than sit down and talk to their patient"
Dr. Monique Tello
Doctors-in-training are often reminded of the classic quote by Sir William Osler: “Listen to your patient; he is telling you the diagnosis,” said Dr. Monique Tello, a clinical instructor at Harvard Medical School and primary care physician at Massachusetts General Hospital.
Still, doctors interrupting patients is an ongoing and exasperating issue in medicine, she said.
“So what is wrong with us? Speaking from my own experience, I can tell you that there's nothing a physician would like to do more than sit down and talk to their patient,” Tello said. “Hard to do that when you have ten, 12, 20 patients on your schedule and only 15 to 20 minutes to fully complete each clinic encounter.”
You’ve probably experienced long waits in the waiting room, which happens when doctors take more time than what’s allotted on the schedule, she said.
Doctors must also answer phone calls and pages; follow up on urgent lab results or imaging studies; and perform endless administrative work, making long, chatty visits “not humanly possible,” Tello added.
When it comes to interrupting, it’s sometimes necessary to get patients to focus on the specific issues that brought them to the doctor, but 11 seconds is clearly not enough time to relay that information, said Dr. Debra Wattenberg, a New York dermatologist.
How to make the most out of your visit:
Doctors offered these tips:
If you have a complicated case: Tell the person booking the appointment you may require extra time so the appointment can be booked correctly, Wattenberg advised.
Be prepared: Take time before the visit to think about the main concerns you’d like to discuss, Ospina said. Write them down so you don’t forget anything.
Hone your story: Try to get the key points out in a few minutes, suggested Dr. Danielle Ofri, a clinical professor of medicine at New York University, an attending physician at Bellevue Hospital and author of “What Patients Say, What Doctors Hear.”
Related
Make your story concise for the specific appointment: When visiting a dermatologist, for example, stick to the skin issues that are current, Wattenberg advised. Your well-controlled rosacea may not be relevant to the changing mole on your leg.
Never leave your most pressing concern for the end of the visit: Make sure it can be given proper attention, Azar said.
Clearly state you’d like to ask a few questions before the visit ends: That will prepare the doctor to leave time to address those questions, Wattenberg added.
It’s always appropriate to ask if an additional follow-up visit or a phone call can be arranged: Ask for it if not all issues were addressed, Azar noted.
If you don’t feel heard, let the doctor know: Clinicians hold a position of power in the interaction, so it might be difficult for patients, Ospina said. But she encouraged them to say: “I don’t feel we have talked about my main concerns.” Doctors likely won’t ignore such a complaint.
If you habitually feel unheard, find another doctor: “It’s not unusual for there to be a mismatch in the doctor-patient relationship,” Azar said. “It might be time to look elsewhere for [your] care. And that’s OK.”