It’s like the healthcare system was designed to frustrate patients. Imagine having to wait seven days to make an appointment to see your car mechanic, being seen more than an hour after your appointment time, spending about seven minutes with the mechanic, and then leaving having no idea what you’re supposed to do next.
While fixing the entire American healthcare system might not be a realistic goal for the individuals who run hospitals and medical practices, there is one thing you can do to help doctors get more done in less time, while improving patient outcomes.
Teach doctors to listen.
What’s the problem?
Waits of six days or more for an appointment to see a doctor were reported by 26% of patients.
While the average person spends 21 minutes in a doctor’s waiting room, 65% of people polled by Angie’s List said they’ve waited more than an hour to see their care provider. Other studies put the average wait time at 24 minutes. And it’s only getting worse as physicians take on more patients.
How’d we get here?
The long waits result from simple supply and demand. An aging population, greater access to health insurance, and insurance plans that mandate seeing a primary care physician prior to a specialist have skyrocketed demand for primary care. At the same time, primary care doctors are retiring while medical students choose specialties over primary care because they are more lucrative, reducing supply.
Usually when demand increases faster than supply, prices rise. Not so in primary care, due to the payment model. While surgeons and specialists can boost earnings by charging for procedures, the only way, under insurance, for a primary-care doctor to increase their earnings is to run through more appointments in a day and get more patients in their practices.
And as volume rises, quality suffers. Newsweek quoted experts who warn that primary-care doctors can only provide quality care when the total number of patients who rely on them for primary care doesn’t exceed 1,800. But primary-care doctors in the U.S. are responsible for the care of about 2,300 patients on average. Clinics that treat mostly poor patients covered by state Medicaid plans assign their doctors up to 3,000 patients.
In a recent survey, most doctors said they didn’t have enough time to spend with patients.
What is this costing us?
Long waiting times discourage people from seeing a doctor when they need to. And waiting unnecessarily stresses both patients and doctors.
And less time with a doctor means less opportunity for a bond to develop between patients and doctors. Newsweek also reported a recent Consumer Reports survey showing 70% of doctors say that their bond with patients has eroded since they began practicing medicine.
This bond is essential to good health. Canadian researchers audiotaped more than 300 office visits with 39 different primary-care doctors and asked patients to rate the visit in terms of the relationship with their doctors. Looking at patient health over time, when patients reported feeling that their doctors focused on their feelings and worries and listened to them carefully, they not only felt better but objective measures showed they had fewer symptoms of disease.
This study joins a growing body of research showing a link between quality of doctor/patient communication and a number of health indicators, including sense of well-being and number of symptoms.
“There is something in the human body that says we are hardwired to get better when we have a certain relationship,” Primary-care Physician Howard Brody explained to Newsweek.
This state of affairs isn’t just bad for patients. A majority of doctors expressed diminished enthusiasm for medicine . Disturbingly, this crazy workload isn’t even paying off. Incomes for the vast majority of doctors (84%) are constant or decreasing.
What can we do?
On average, doctors allow a patient to describe their symptoms for 23 seconds before interrupting them, according to one Canadian and U.S. study. And in a quarter of visits, the doctor neglected to ask the patient what was wrong entirely. Doctors and patients reported that doctors forget important information their patients tell them nearly a third of the time, according to a Markle Foundation survey.
So what are doctors doing instead of listening? The research indicates that they’re looking at their computers. A new study in the Journal of General Internal Medicine confirmed what many have suspected: Doctors spend more time with computers than they do with patients. The study showed medical interns spent 40% of their day with a computer and only 12% of their day with patients. Other popular activities include discussing cases with other healthcare pros and educational activities.
It’s hardly a habit unique to doctors. No one listens to anyone. We’re all forming responses in our heads, waiting for our turn to talk. But for doctors, the results of this habit can waste precious time at best, and be deadly at worst.
Another study revealed doctors spend 1.3 minutes on average conveying crucial information about the patient’s condition and treatment. The doctors thought they had spent more than eight minutes, and wouldn’t have known otherwise except researchers taped 34 physicians during more than 300 visits with patients. Not only that, but the doctors used medical jargon that patients don’t understand.
Another study showed that three out of four doctors failed to give clear instructions on how to take medication. Half of patients walk out of doctor’s appointment with no clue when and how to take their meds.
Doctors ask patients to take new medications, eat or exercise differently, and start and stop habits like smoking cigarettes or shooting heroin. To patients, these feel like huge changes to their lives. If your doctors are complaining about patients who won’t comply, consider whether the problem is the doctor-patient relationship.
Having short conversations saves time in the moment, sure. But it wastes time overall in non-compliance, follow-up visits, and overall worse health. Healing requires a therapeutic relationship. This kind of relationship needs an emotional connection between the doctor and patient.
The first step to connecting with someone emotionally is listening. Doctors and patients need to understand each other and believe in each other. Interrupting a patient before they reveal an important symptom or piece of medical history leads to less accurate diagnosis. A famous study of physicians’ performance showed that for 30 different medical conditions, patients received only 55% of recommended care.
To achieve better results you need to teach doctors to:
- Listen to understand.
- Recite what patients say in their heads instead of forming a response.
- Never interrupt. Let the patient finish speaking on their own.
- Recap and paraphrase to ensure doctors understand.
- Ask clarifying questions before moving on to new topics.
- Do comprehension checks. After instructing a patient a doctor should ask the patient to explain to the doctor what was explained to them in their own words.
The healthcare system can be frustrating. The intense pressure on doctors to see as many patients as possible leaves them rushed, stressed, and alienated from their patients. This negatively impacts patient health and doctor job satisfaction.
Ironically, by interrupting patients and not taking the time to listen, doctors are actually wasting time. While we can’t fix the system, we can teach doctors to actively listen to patients, to understand them, and to ensure patients understand instructions. This will not only save time, it will also make the healthcare experience more effective and pleasant for everyone involved.
How important do you think listening is to good healthcare? How do you teach doctors how to listen? Let us know in the comments!
Images by Abby Kahler