It is becoming increasingly obvious that we physicians are doing a pretty shabby job of listening to our patients. In a recent op-ed piece in the New York Times I read that a recent study (Doc, Shut Up and Listen by Nirmal Joshi, Jan. 4, 2015) found that on average doctors waited only 18 seconds before interrupting the patient. It is not unusual for me to hear complaints from friends about physicians they have visited who didn’t seem to be interested in what they had to say. In fact, it has happened to me.
The problem of physicians not listening isn’t just about patient dissatisfaction. The failure to hear what the patient said, or could have said if given the chance, can result in delayed or missed diagnoses and the ordering of costly and unnecessary diagnostic studies.
So, if physicians aren’t listening what are we doing during encounters with our patients? Many of us, and soon most of us, have our noses in computer screens looking through bloated and poorly organized electronic medical records or mouse clicking through templates to create the illusion of meaningful use. But, for the moment let’s stop beating that tired and dysfunctional horse of EHR’s and look deeper into what else could be interfering with listening.
The knee-jerk response that is most often offered is that we just don’t have enough time to listen. How often is that really the case? I wonder if we physicians had 40 minutes for an office visit instead of 20 minutes, how many of us would do a significantly better job of functional listening? I have always suspected that the notion that longer visits are automatically more effective at getting to the heart of the patient’s problem and moving toward a solution is a myth.
Listening is a skill. If you hand me a Rubik’s Cube and ask me to solve it, you could give me 15 minutes or give me an hour it won’t make any difference because I have no experience with Rubik’s Cubes. Learning how to ask questions that have a high likelihood of getting at what is really troubling the patient and then listening to their responses is a skill. A few master physicians are born with that ability and some doctors will never get it. However, it is a skill that most of us can be taught if medical schools and house officer training program knew how to teach it.
In the Times op-ed piece, Nirmal Joshi, the chief medical officer of Pinnacle Health Systems, Harrisburg, Penn., describes a physician training program in Harrisburg, in which the doctors participated in mock patient interviews in which the patient-actors provided feedback. The physicians also were provided with physician-coaches in real life clinical encounters. The result was a 40% increase in patient satisfaction. Other studies have shown that increased satisfaction correlates with improved outcomes.
You could argue that incorporating these listening skills are going gobble up more time. It probably would, more so on the steep slope of the learning curve. There will always be patients who ramble on and are hard to redirect even by the most skillful history taker. However, with practice I think physicians will find that listening with care will often not take as much time than they fear. It will certainly make the encounters more satisfying.
But, let’s look at that issue of how we are spending our time again. How often are office visits driven by the physician’s agenda and not by the patient’s? How much time do we spend lecturing and badgering patients in an attempt to follow advice that we think is important but they obviously haven’t? That wasted time could have been better invested in listening for the answer of why they haven’t complied in the past.
Finally, is the issue of caring. Unfortunately, this may mean a significant shift in attitude for some of us. If we genuinely care what the patient thinks is important, finding the time to listen won’t be that difficult.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “Coping with a Picky Eater.” E-mail him at email@example.com. Scan this QR code to view similar articles or go to pediatricnews.com.