When we go to the doctor, we expect that they will make an effort to understand our medical concerns. It seems only reasonable that patients have the chance to tell their doctor about what’s bothering them, but unfortunately, it doesn’t happen as often as you might think.
In a study recently published in the Journal of General Internal Medicine, researchers from the University of Florida, the Mayo Clinic, and others analyzed video recordings of 112 clinic visits to find out how clinicians ask about and listen to patients’ concerns. (Sound familiar? An early abstract of this study was presented at the 2017 Lown Conference.)
First, the researchers wanted to know how often clinicians elicited the patient’s agenda, either by asking an introductory question (i.e. “What brings you here today?”) or statement (i.e. “So you’re having stomach pain”). Shockingly, clinicians elicited patients’ concerns in only 36% of the visits.
Shockingly, clinicians elicited patients’ concerns in only 36% of the visits.
Primary care doctors were more likely to ask patients about their concerns compared to specialists, possibly because the specialist knew that the patient had been referred for a specific problem. However, the authors argue that even in a specialty visit that is presumed to be about one particular problem, “it is invaluable to understand why the patient thinks they are at the appointment and what specific concerns they have related to the condition or its management.”
Another significant difference was total time of the visit; visits were typically 8 minutes longer in encounters where clinicians asked patients about their concerns. The gender of the patient and clinician did not make a difference in whether the clinician asked about the patient’s concerns; neither did usage of shared decision-making tools.
For visits in which the clinician did elicit the patient’s concerns, researchers measured how long the patient spoke uninterrupted. Clinicians interrupted patients 2/3 of the time, and the typical (median) amount of time before they interrupted was 11 seconds.
Building trust by getting to know the patient in the beginning of the visit makes it easier to have shared decision making conversations later.
Asking patients about their concerns and listening to them is imperative, because it “allows the clinician and patient to engage in meaningful conversations, laying the foundation for patient-centered care,” the authors write. Building trust by getting to know the patient in the beginning of the visit makes it easier to have shared decision making conversations later.
Clinicians may also find that what they believe to be the problem is in fact a symptom of a larger problem. As Dr. Bernard Lown wrote in The Lost Art of Healing, “I am convinced that listening beyond the chief complaint is the most effective way to get to the bottom of most medical problems.”
Why are we so bad at eliciting patient concerns?
So why are we doing so poorly at eliciting patient concerns? Time constraints, limited education about patient communication skills, and physician burnout likely all play a role, the authors write. When doctors feel rushed to get through the visit, they interrupt more to try and get to the problem more quickly. When they feel disengaged and exhausted, they may not have the energy to connect to the person in front of them. And even if they have the time and energy, they might not have the knowledge or training to elicit patient concerns.
As discouraging as the results of this study might be, this kind of research gives us an opportunity to work on removing these barriers to real communication and move toward better doctor-patient partnership.
Don’t know where to start? How about asking your patient, “What worries you most?” The answer may surprise you.