At the blog “Mind the Gap”, the author Stephen Wilkins. MPH, writes about the Patient Experience. I was hooked the second he wrote, “In only 26% of the visits are patients allowed to complete their opening statement (agenda) without interruption (by the doctor); in 37% the physicians interrupted; and in 37% physician never asked about the patient’s visit agenda.”
It seems to be the case in most of my visits to the doctor that no one is really listening to what I’m saying. The nurse, technician, greeter, whatever takes me back to the exam room, takes my vitals, and asks me questions. I carefully answer them thinking that perhaps he/she is really making note of what I’n saying. Then I sit for 30-45 minutes in the quiet, reading a couple magazines that I’m not really interested in to occupy my mind while I wait, never knowing for sure when the doctor or PA will come bursting through the door. Invariably just as I find a article that is of interest, the door opens.
The doctor (or PA) comes in and looks at my file or, in the modern office, logs onto the computer and reviews my file. He/she sometimes asks about my medical complaints and I repeat what I said to the previous questioner but he/she really doesn’t engage before scribbling something in the file or typing away like a high-tech secretary. It’s as if what’s in my file is more important than what I am saying. Before I know it, I’m shepherded out into the hallway and towards the checkout counter. Total time spent with me? About five minutes. Questions answered? Much less than asked or I planned to ask.
The modern physician’s office is operating to get the most patients through in the least amount of time. I appreciate efficiency but if this was an automobile factory, the cars would be going out the door missing major parts! It’s no way to operate. It’s not efficient if you’re not producing a complete product.
Stephen Wilkins, doesn’t offer any suggestions for resolving the problem in this posting. He just points it out. One comment on the blog writes:
We hear on Dr. Oz and WebMD that we are supposed to enter our doctor’s offices with lists of questions and concerns to make sure we understand our conditions and get the proper treatment. Do this in “real life” and you, the patient, is often seen as “troublesome,” or “difficult.” Some doctors become downright nasty if you try to engage them in a two-way conversation about your condition.
But it remains to me to confirm this. The next time I visit one of the many doctors I see, I will try this method and see how it goes.
In a later blog posting, Wilkins poses one possible solution: “Would Increased Reimbursement And Longer Visits Improve Physician-Patient Communications?” He answers the question in the first sentence: “no”. He then writes that physicians agree, in principle, communicating with their patients is important but they don’t have the time for it and aren’t reimbursed for spending time with patients. On the face of it, this is probably true.
“After all we know that physicians, particularly primary care physicians, are already overextended. We also know that the traditional fee for service model, which pays physicians on a kind of piece work basis, is not well-suited to managing “episodes of care” for a burgeoning chronic disease population. In other words, today’s reimbursement is not properly aligned with the realities of care delivery.”
So, Wilkins poses the situation where doctors would be given ample time to spend with patients and would be reimbursed for that time. Would that solve the problem? Again, Wilkins says, “no“. He explains that listening and communicating with patients is not something taught in medical school. He writes, “Studies show that the majority of primary care physicians today employ a physician-directed, paternalistic style when talking with patients.” And, points out that this is the way it’s been for at least the last 80 years. On the other hand, patients are taught from early age not to question the doctor but to only speak when spoken to and answer the questions when asked. So, you have a situation where neither side is in a position to advance the cause of increased doctor-patient communication so increasing the time or reimbursement on the physician side will not correct the problem.
I do have one doctor I feel breaks down this wall and communicates well. He is a very talented diagnostician and it’s because he listens very carefully, employs the most advanced diagnostic methods, and spends as much time with me needed to isolate and treat my problem. By the time, he’s ready to provide a solution to my medical problem, it’s very often right the first time because he took the time to listen. The other side of the coin, however, is that he’s often backed up for a couple hours at the end of the day because he spent that time with every patient. In his case, I don’t mind waiting because I know that the time I spend with him is time well spent. This doctor is a rare case though. Most of my other doctor visits are only a few minutes long and I spend considerably more quality time reading magazines than seeing the doctor.
So, what’s the solution? Wilkins offers that physicians should be working on their “patient-centered communication techniques” and patients should be “focused and prepared, i.e., with a prioritized agenda, clearly articulated expectations, realistic requests for referrals, tests and medications, understanding of time limitations, and so on. ” This would at least present the situation for changing the dynamics of the doctor-patient communication. The rest is up to how the physician and the patient carry forward with it.
© 2012 DevonTexas