The 11 Second Visit
Researchers analyzed 112 recorded meetings between doctors and patients at general practices in Minnesota and Wisconsin, including at the Mayo Clinic and its affiliated clinics, and found that doctors only spent 11 seconds on average listening to a patient describe their reasons for visiting before interrupting. This is not good. They also found that 67 percent of patients were interrupted after responding and only 36 percent of doctors even ask questions that invited patients to direct the focus of the conversation. Want more?
In primary care visits, 49 percent of patients were able to explain their agenda, while in specialty visits, only 20 percent of patients were allowed to explain their reason for visiting. For specialty care visits, eight out of 10 patients were interrupted even if they were allowed to share their agenda.
The authors don’t know whether the reason is lack of communication training, time constraints or burnout but they are sure that “we are far from achieving patient-centered care”.
I don’t know the answer either. We live in a world of limited attention span so this could be what is now “normal” in these overstimulated times but I think it is more than that. I think it still goes back the “environment” we are put in, as Dr. Neuhofel spoke about in his piece. Doctors are burdened by shorter visits, and emphasis on productivity, and shackled by bureaucratic tasks that are meaningless to the encounter. All in all, 11 second interruptions are an embarrassment and prove we are not able to be the doctors we wanted to be.
It’s time to take back control and push back on the system. If you can’t do this WITHIN the system, which is highly probable, then we need to do it OUT of the system. We need to break free from the forces that are causing this shamefulness because the patients will only blame us and that isn’t fair. Or is it? Would love your opinions on this.
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The eleven seconds thing is a complete gotcha deal because unless they really think about it the average lay-person is going to think “Only 11-seconds!!! Those bastards!” But think about this hypothetical doctor-patient interaction:
Me: What brings you in today Mr. Smith?
Mr. Smith: My right shoulder has been killing me for 3 weeks.
I looked at my watch while I did this conversation in my head…5 seconds including my interrogatory. Let’s continue:
Me: Did you injure it in any way, have a fall or anything you noticed that brought it on?
Mr. Smith: Well, it seemed to start when I was bowling.
Me: Do you bowl with your right arm?
Mr. Smith: Yes.
Me: Did you feel a pop?
Mr. Smith: Yes.
Me: Do you have a bulge on your upper arm?
Mr. Smith: Yes? How did you know?
Me: Because I am a doctor and it sounds like you tore your biceps.
20 seconds total. It would then take me about 30 seconds to examine his shoulder and upper arm. Then it takes me SEVERAL MINUTES to put that into documentation in the EMR. 🙁
The more concerning (and a little unbelievable) part of the results of this study is that only 1/3 of doctors “ask questions that focus the conversation”. That seems a little hard to believe, on the other hand I have seen my share of mis-diagnoses from colleagues who obviously spent less time than the 2 minutes I took me to come up with the correct diagnosis so maybe I have a warped perception.
This is such crap!
I don’t even let them start talking!
Only amateurs let patients begin talking!!
You have to take control of the visit!!!
Administrators and our thought leaders (including many docs that have gone to the “dark side”) just cannot understand the concept that patients are not widgets.
A lot of those same patients that want you to sit and listen to every problem, and occasionally their life story, also don’t want to pay you to do it. Every second, every action in a business ha an economic cost, something no one questions if the venue is anything other than the doctor’s office. I’ve tried to explain the concept of DPC to well-to-do elderly family members, and all I hear is “we can’t afford it” (they can). So they won’t lose their death grip on Medicare, with all its unfunded mandates, onerous administrative burdens, and general time-and-money wastefulness. The same can be said for some of the Blue/Aetna/United/etc. clientele.
I know there are exceptions and some Medicare patients are starting to move toward DPC, which is encouraging. The larger take is that patients WILL blame us for an 11-second interview, and take no responsibility themselves for setting the terms of the relationship.
If one has no understanding of something’s process or quality, one only contemplates it in terms of cost and time.
They equate a nuse’s aide listening to the heart for 15 seconds to count the pulse with a cardiologist’s listening to consider a murmur. Often, an adult patient’s account of a healthcare interaction is told in a narrative you’d expect from a child. “I blacked out and went to an ER in the ambulance, they did all the tests and nothing’s wrong.” Many people have no understanding of what we do; many don’t care. When they do, they bring a buyer’s cynicism to the clinic as though they are shopping for eye makeup.
These are learned habits. It is impossible to fight against a lifetime of cultural teaching. 11seconds of broadcast silence is intolerably painful. Perhaps that is too long.