In a typical patient visit these days, there seem to be more interruptions than interaction.
Patients are battling illness or trying to convey a series of critical points to a physician who is either furiously typing and likely still reeling from previous patient visits or anxious to get through the rest of the day. It doesn’t make for the best collaboration, according to internist Danielle Ofri, MD, Ph.D.
In her newest book, “What Patients Say, What Doctors Hear,” Ofri, an associate professor of medicine at the New York University School of Medicine, examines the state of physician-patient communication and what can be done to reduce the distractions and get back to focusing on improving the patient’s health.
Ofri recently spoke with Medical Economics about her fifth book, what works with her own patients and to offer advice to peers who may be struggling to make meaningful connections with patients.
Medical Economics: What do you think are the most common barriers to good patient-physician communication?
Ofri: The first one is time. We all know that time is getting shorter and shorter for physicians, with more and more to do in that time. I think almost all doctors would agree that if they had an hour with each patient, they’d be excellent doctors. Unfortunately, no one is giving us that hour.
The other thing that has come along, of course, is the electronic health record (EHR), which has greatly impacted physician-patient communication. There are definitely some advantages: the chart doesn’t get stuck in dermatology clinic, or the X-ray is not in the surgeon’s back pocket. Those are great things that definitely enhance doctor-patient interaction, but the EHR has sort of sprouted like a disease, growing more parts and metastasizing to every part of the visit. You just can’t get through the visit without being glued to the screen. We end up mainly talking to our computers and the patient is wandering off into space.
Medical Economics: You openly admit in the book that being a good listener as a doctor is difficult. What has helped you in your own patient interactions?
Ofri: We all know the data that physicians interrupt patients in eight to 10 seconds and how awful that is, so I tried an experiment where I let patients talk without interrupting them. We all worry that patients will talk forever, but I learned quickly that they don’t do this. Most patients, within a minute, get out what they need to say and then they are done and ready for questions from the physician.
Even patients who answer “all-of-the-above” for the entire review-of-systems only spoke for four minutes. And then our future visits are much more effective and efficient. So although it seems counter-intuitive, I find it very efficient, especially with my patients with multiple complaints, to give them a chance—even once—to talk it all out.
They feel like they are truly being listened to and cared for, and I feel like I’m not going to miss anything. If I’d cut them off at the chase after the first symptom—like I usually did—they might never get to that second thing they’d planned to say like, “I think I had a stroke last week.” I’d miss that and that would be terrible medicine.
Medical Economics: Does that help avoid the “doorknob” comment, where a patient says what often turns out to be the most important thing when the physician is exiting the room?
Ofri: That helps alleviate that, but I think it is also important to say at the end: “Is there anything else we missed?” Often that’s enough to reassure the patient that you are listening.