July 25, 2018

How long do doctors wait to interrupt patients? (Hint: Not long.)

Daily Briefing

    Read Advisory Board's take and learn what you can do to help improve physician-patient communication.

    Doctors listen to their patients for an average of just 11 seconds before interrupting them, according to a recent study published in the Journal of General Internal Medicine, leading some experts to argue that doctors' propensity to talk rather than listen may be detrimental to patient care.

    Study details

    For the study, researchers from the United States and Mexico analyzed 112 recorded clinical encounters between doctors and patients at general practices in Minnesota and Wisconsin, including Mayo Clinic and its affiliates. The researchers sought to determine how often providers elicit patients' concerns.

    Findings

    The researchers found relatively few encounters—just 40 out of the 112 examined—in which the provider prompted the patient to set the agenda and share their concerns, such as by asking, "What can I do for you today?" or, "Tell me what brings you in today." The researchers found those prompts were more likely to occur during primary care visits than in specialty care visits.

    But even when providers elicited patients' concerns, the researchers found physicians interrupted the patient in 67% of encounters. Those interruptions often occurred after a median of 11 seconds, with some providers interjecting within three seconds and others waiting up to 234 seconds.

    Nearly 60% of the time providers interrupted patients to ask a closed-ended question, requiring a "yes" or "no" response.

    Discussion

    Lead study author Naykky Singh Ospina of the University of Florida and Mayo Clinic said the results "suggest that we are far from achieving patient-centered care." Ospina added that interrupting a patient "may clarify or focus the conversation, and thus benefit patients," but only "[i]f done respectfully and with the patient's best interest in mind."

    However, Ospina said, "It seems rather unlikely that an interruption, even to clarify or focus, could be beneficial at the early stage in the encounter."

    Bruce Lee, associate professor at the Johns Hopkins Bloomberg School of Public Health, in Forbes wrote that the findings do not necessarily mean "doctors are just naturally uninterested in listening to you." He added, "[W]hen a majority of doctors aren't taking the time to listen, it is a systems problem and not just an individual doctor problem."

    Lee writes that the fast interruptions could have several causes, including doctor fatigue and the fact that the typical 15-minue office visit "is just not enough time to see a patient." Lee argued, "[T]his rush-rush situation is driven by insurance reimbursement and administrators who don't actually see patients but are trying to increase revenue. Ironically, such rush-rush ends up costing everyone a lot more money."

    This can ultimately be detrimental to a patient's care, Lee wrote. "Medical costs, productivity losses, suffering, and deaths go up when patients don't receive the right diagnoses, preventive care, or treatments," he wrote. "When you feel unheard, you may seek alternative providers, who at least will take time to listen to you (or at least pretend to listen to you) regardless of whether they provide legitimate evidence-based care," which can result in lost revenue for hospitals and clinics and poor outcomes for patients (Interrante, Newsweek, 7/22; Lee, Forbes, 7/22; Marshall, CBS Boston, 7/23).

    Advisory Board's take: What you can do to improve physician communication

    When we interviewed nearly 2,000 patients about their relationships with their personal physicians, we found that communication goes a long way in driving patient loyalty. In particular, patients who say their "PCP respects me" and "explains possible causes of illness," and those who say "the staff are patient and helpful," are more likely to stay with, follow, and recommend their physician.

    Better physician communication does not necessarily require much more of the physician's time. Rather, small gestures that reassure the patient and communicate that their concerns have been heard can have a significant impact.

    “Exemplary communication only took seven seconds longer”

    For instance, one 500-bed-not-for-profit medical center in the Southeast used simulated exercises to help physicians improve their patient interactions. They had physicians simulate different types of patient interactions, for instance, entering the room and delving right into their communication versus knocking, entering the room and introducing him or herself before launching into the visit. They found that the 'exemplary' patient interactions, versus the normal, non-exemplary patient interactions, only took seven seconds longer for physicians.

    Cleveland Clinic was able to greatly improve their physician communication after they noticed that their 2008 CMS Patient Satisfaction Survey scores were quite low—in the 14th percentile for physician communication skills and in the 4th percentile for staff responsiveness.

    After a half-day training for all 43,000 staff members to help them develop their patient communication skills, HCAHPS scores for doctor's communication increased to the 63rd percentile. Meanwhile, their overall increase in HCAHPS patient satisfaction scores increased by almost 40 percentage points to 92% by 2012.

    To learn more about how to make the case to physicians about the need to engage in patient experience initiatives, and how to leverage data to strengthen physicians' communication skills, read our report about engaging physicians in the patient experience.

    Read the Report

    Then, download our infographic which covers the five myths that physicians believe about the patient experience

    Download the Infographic

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