Doctors Fast
to Interrupt Patients' Concerns
The Journal
of the American Medical Association January 20, 1999;281:283-287.
When it comes to a doctor's visit,
the patient has an average of 23 seconds to state their concerns before a
physician interrupts. Overall, only 28% of doctors know their patient's full
spectrum of concerns before they begin to focus on one particular concern, and
once the conversation is focused, the likelihood of returning to other concerns
is only 8%. Physicians commonly redirect and focus clinical interviews before
giving patients the opportunity to complete their statement of concerns. The
problem is that the conversation rarely veers back to other concerns the patient
might have, often leaving patients with the feeling they may not have discussed
all their problems or even the most important one.
If the physician doesn't actively
ask if all the points have been covered, patients tend to have more "doorknob"
questions -- that is, they bring up an important problem just as they are
leaving the office. The good news is that patients need only slightly more than
23 seconds to state their problems. Most people have 2 to 3 things they want to
discuss with their doctor, and if given the chance, raise those issues in an
average of 32 seconds. Our findings show that if those concerns are clarified at
the beginning, you are less likely to have late-arising concerns, therefore the
visits are more efficient and on average, the agenda setting portion of the
interview takes about half a minute.
The best thing (for patients to do)
is to prepare before the office visit, write down their concerns, so that when
they get in to see the doctor they are able to verbalize very clearly and at the
beginning what their concerns are. The researchers found that 75% of physicians
elicited patient concerns, that is, they asked questions such as "How can I help
you?" or "What brings you here today?" When a physician did not ask such
questions, 35% of patients had late-arising questions, compared with 15% of
cases in which the doctor did ask such questions. It's infrequent that the
doctor asks if there are other concerns before they -- in my opinion --
prematurely start to delve into the first concern stated. So by keeping the
agenda open a little longer and saying what else do we need to address today, it
allows the doctor and the patients to plan the office visit to be more efficient
and effective.
The
Journal of the American Medical Association January 20, 1999;281:283-287.
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