Three Reasons Why Doctors Need To Spend More Time Talking and Listening To Their Patients

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Since most physicians probably will not be able to get beyond the first couple of lines of this post without yelling at the monitor…I will get to the 3 reasons…and if you stick with me …I’ll present my case for why they are so important.

  1. Your visits will be more productive…and shorter
  2. You will be a better diagnostician and a much better doctor
  3. Your patients will sing your praises to all their friends and family

Reason #1- Your visits will be more productive…and shorter.

Quality of time quotePhysician experts argue that the best way to improve productivity and time management during the office visit is by improving the way physicians talk with their patients.  Most of you are probably screaming this is not possible because patients:

  • Show up with 3-4 complaints/visit
  • Just want a “quick fix “or prescription
  • Are unfocused and make rambling opening statements
  • Appear totally disinterested and unengaged
  •  Won’t do what I tell them

 

Let’s stipulate that all these arguments are true.

Now suspend your judgment for a moment and consider this.

Where is it that patients are taught how they are supposed to behave when in the presence of their doctor?   Have you ever talked to them about such things?  Do you imagine their previous doctors advised them about such things?  Is there a school people are supposed to go to learn how to talk productively with your doctor?

The fact is that patients aren’t taught these things….ever.  They learn these behaviors through the school of hard knocks.  We have all been socialized from childhood to assume the “passive, subservient “sick role” in the presence of our doctors.  That’s not anyone’s fault…it is just the reality of the way health care have evolved.

Now imagine there was a school for patients where they learned things like how the medical interview is structured, what patients can do to prepare for their visit, why time is limited, how to make the best use of the time available, and so on. Then imagine you reinforcing these “learning” at each of your patient visits through repetition, encouragement, and changes in your communication behavior.  In relatively short order patients would begin to “reciprocate“your behavior with the behavior you desire…and viola you have set the stage for shorter, more productive (and organized visits).

Reason #2- You will be a better diagnostician and a much better doctor

Sir William Osler, a founding father of modern medicine, once said “Listen to the patient – they will tell you what’s wrong.”  Numerous other luminaries have said that a doctor’s patient communication skills (talking and listening) are as important as their clinical skills and knowledge.  Talking and listening is how physicians arrive at the correct diagnosis and treatment.  Strong patient communication skills are needed to engage and activate patients.   Talking and listening is therapeutic and to patients.

Some patients will get better with a commonsense explanation of their difficulties; others for some unknown reason remain unchanged. Some patients will respond to friendliness on the part of their physician; others require a more formal attitude. Some can establish rapport with their physician even though they appreciate his intellectual shortcomings.       M. Balint 1957

Hospitalist QuoteAs physicians come to rely upon EMRs, there is a risk that the computer will come between the patient and physician.  This will result in even less “talking and listening” between patients and physicians, more   disengaged patients, and even poorer outcomes.

Reason #3 – Your patients will sing your praises to all their friends and family  

Let’s face it…with few exceptions…most physicians’ patient communication skills need improvement.   Poor physician communications skills top the list of complaints patients have about their doctor, i.e., physicians that don’t listen, physicians that ignore what they have to say, physicians that don’t provide enough information, and so on.    Many of us have never been exposed to a physician with superlative patient communication skills.   We don’t know what we are missing.

Given how “average” most physician communication skills are…. imagine how easy it would be for a physician with good communication skills (patient-centered) to compete with other physicians in your group or local market.  Soon such physicians will also be rewarded for their ability to create exceptional patient experiences simply by virtue of their ability to talk and listen to patients.

Is what I talk about here counter intuitive…yes.  Does it requires some out of the box thinking…definitely.   Do I have a solution for helping patients and physicians accomplish what I talk about here.   Absolutely.   Contact me to learn more.

That’s my opinion…what’s yours?

 Sources:

Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?  Center for Study of Health System Change. Issue Brief. April 2010.

Balint, M. The doctor, his patient and the illness, Inter-national Universities Press, New York, 1957.

Rosenow, E., Patients’ Understanding of and Compliance With Medications:  The Sixth Vital Sign. Mayo Clinic Proceedings. August 2005.

Cene, C., et al. The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication. Journal of General Internal Medicine. July 3, 2009. 24(9):1057–64.

7 Comments

  1. Grea Idea and a great thing for folks who figure out how to do it. Sadly the models pushed bu the gummit and our current sytem don’t lend themselves to listening to ourselves much less our patients. Some of us still mange to do so anyway

  2. Lori says:

    How about asking docs to be open minded when dealing with educated patients? Not all patients are dolts – I am tired of being treated like one by some of my docs. It would be wonderful if all docs could be like my PCP – he hears me when I bring him current research on my complex health issues, and supports me in seeking cutting edge treatments he may not have heard of – before I walked into his office with the latest journal articles on neurological imaging, for example,
    I believe patients DO need to be educated on how to present their symptoms to doctors, and that they DO have a responsibility to learn about their conditions. Docs can easily guide them by providing a simple handout to structure a patient’s next visit. It’s not rocket science – it’s a simple form. The Internet doesn’t just have sketchy info on it anymore – Medscape, PubMed, Google Scholar are all there to provide patients (AND DOCS!) with current info on all conditions.

    • Lori,

      Great point about doctors needing to be sensitive to the different levels of “knowledge and skills” patients bring. Beyond one’s communication skills, it seems that many physicians simply can’t recall much about patients from one visit to the next (other than what’s easily “findable” in the written record).

      Here’s a quote, part of which I included in my post, from 1 1957 article by an early physician thought leader in the physician-patient communication space:

      Some patients can establish rapport with their physician even though they appreciate his intellectual shortcomings; indeed Balint cites a case in which the patient appeared to benefit by having a bad doctor (because it motivate the patient to pursue a subject beyond the physician’s knowledge.

      Thanks for your comments.

      Steve Wilkins

  3. Marian Thier says:

    I’ve coached a medical practice for almost a decade and we continue to work on the doc’s and staff’s communication skills among themselves, vendors and patients. We focus on asking probing questions, differentiating listening styles, seeking feedback, customer-interaction-cycle, motivational preferences, paraphrasing/summarizing, and body language. No wonder we’ve been at it for so long, and the payoff is far greater than any of us imagined.

  4. Marian,
    Thanks for sharing you experience. I’d like to learn more about your work.
    Steve Wilkins

  5. bhava veerubhotla narayana says:

    In India our problem is a doctor works 16 hours a day . seeing 50 patients in the morning prescribing diagnostic tests and in evening to prescribe drugs.In between he has to squeeze time for seeing in-patients.Doctors donot invest in patient education or encourage patients to talk. the article is excellent. i wish to share with my doctor friends in face book . can you mail link to pharmeds AT gmail. I publish India s only patient education news letter.
    Pl share with friends
    http://www.scribd.com/doc/102530950

  6. Actually, there is a “patient school.” I don’t want to sound self-promotional but I thought exactly as you do. Where would patients learn? How To Speak Doctor (R) is a course (online) which does precisely what you describe—how to find a doctor; get ready to go into visits, participate in them with doctors and, equally important, leave understanding care plans; emergencies/after hours; searching for elusive diagnoses; and hospitalizations. Patients and families are “out there” and lost, millions each day. They should not have to be. Glad you wrote this post. It is such a serious issue.

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