The title of this blog, “It Only Takes 18 Seconds,” is adapted from a New York Times Op-Ed article published Jan. 4, 2015, by Nirmal Joshi, MD, FACP, titled “Doctor, Shut Up and Listen.” Joshi wrote:
“A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60% of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms. Evidently, we have a long way to go.”
Joshi discussed the ongoing problems with doctor-patient communications. He presented the case of a patient who went from one doctor to the next, seeking a second opinion, with complaints of a rapid heartbeat and feeling stressed. The patient finally got the correct second (sixth) opinion, when the sixth doctor listened to her and took a thorough history. A review of medication history revealed the patient took an over-the-counter medication for weight loss containing ephedrine. This chemical was the cause of her symptoms. She stopped the medication, and her symptoms stopped. It was that simple, but the previous five doctors did not listen to the patient and did not take a good and thorough history.
Doctor-patient communication has deteriorated in recent times. Patients are expressing dissatisfaction because doctors are not listening to them. Doctors enter the exam room, start the clinic visit by introducing themselves and then they bury their heads into their computer screens.
The doctors start typing, clicking, checking boxes. The patients remain silent, waiting for a chance to explain their complaints, to detail their medical histories or just vent.
Welcome to the 21st century’s health care world. Welcome to EMR. In a previous post “The Doctor, the Patient, the Movie,” I talked about the importance of empathy in the doctor-patient relationship. In that post, I wrote that while EMR has positively revolutionized health care in some ways, it has also negatively affected physicians’ satisfaction as well as negatively affected the patient-doctor relationship. After a conversation with a patient, I have worked to reconcile talking with the patient, while at the same time working on my computer. It is a difficult balance to maintain.
It is so important for the medical community to discuss the importance of motivational interviewing and empathy in the doctor-patient relationship. Patients and the media are talking about this issue. I hear this discussion around my kitchen table. I hear my family members talk about their experiences with their doctors. All doctors have medical boards, expertise in their fields, good bedside manners and state-of-the-art skills. These are all important assets. But these assets, combined, are not what leave an impression on patients. Patients will think highly of doctors who listen!
How do my listening skills measure up? I do not know what my patients think. I have not done research or an audit to know the answer. But I do hear now and then from patients talking about their experiences with doctors (myself included), and I have always noted how much emphasis the patients place on doctors who listen vs doctors who do not. In our practice, we offer a simple, 1-page survey to patients upon check out. The survey asks about scoring their satisfaction with the clinic’s staff and provider (score from 1-10), plus a box to write comments. I recently asked our manager to show me a sample of the surveys. In the comment sections, many patients wrote the word “listen” as the main impression they were interested in sharing.
Several authors recently published recommendations for doctors to consider examining empathy within themselves and perhaps consider seeking training or coaching in this area. The importance of eye-to-eye contact has been emphasized, as well as other small attributes toward an effective doctor-patient communication in the exam room. Also, specific recommendations have been published to help doctors reconcile their obligations toward listening to and interaction with their patients and their obligations to fulfill the EMR tasks.
Hopefully we, as doctors, may strive to try to refrain from interrupting our patients “18 seconds” after they begin telling their histories. And, we should be listening more to our patients.
Comments are welcome!
New York Times. “Doctor, shut up and listen.” Available at: https://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html