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Did you know?

• Physicians, on average, interrupt patients within the first 23 seconds of their opening comments.[i]

Interruption is a pervasive communication style with doctors.  In a well-known study by Beckman and Frankel patients were allowed to complete their opening statement expressing their agenda in its entirety in only 23% of physician interviews.  The average time to interruption was 18 seconds.  This study’s findings have been replicated by several others.  In a more recent study of primary care residents, patients were allowed to speak for only 12 seconds on average before they were interrupted.  Female patients experience interruption more frequently than males. In contrast, studies have suggested higher rates of patient satisfaction with physician visits during which patients and doctors interrupt at similar frequency and also with visits in which there is more “reflective” silent time during the conversation.  Perhaps the tendency to interrupt extends to all physician derived professional communications, as in my case with the neurosurgeon on the phone.

Why do physicians interrupt?  In practical terms, throughout the course of a given day a physician may be tasked with listening to twenty to thirty patient derived histories and with solving difficult problems for each of these patients in a matter of ten to fifteen minutes. This is a tough, if not impossible job.  Consequently, once a physician believes that the meat of the story is out there, he or she may respond and interrupt before hearing details that the patient (or colleague) feels are important.  In more abstract terms interruption is a communication strategy that reinforces physician dominance in the hierarchy of the patient-physician relationship.

http://thehealthcareblog.com/blog/2012/06/12/why-doctors-interrupt/

It is interesting to note that there are a plethora of sites dedicated to how do doctors talk to patients. The following link is to the final session of a seminar given at the Mayo clinic. This is a woman talking to doctors about how to talk to patients. I thought you would like to know that if communication in marriage is hard, it is equally as hard in the medical field.

http://mindthegap.smarthealthmessaging.com/2014/03/13/the-power-of-conversations-between-physicians-and-patients/

• Physicians do not ask patients if they have any questions in more than 50 percent of outpatient visits.[ii]

• Physicians typically spend less than one minute of a typical visit discussing new prescriptions.[iii]

• Patients are afraid to ask their doctor questions for fear of appearing to challenge them.[iv]

Next time: If you are hospitalized

[i] Marvel MK, Epstein RM, Flowers K, Beckman HB. (1999 Jan 20). “Soliciting the patient’s agenda: have we improved?” JAMA, 81(3): 283-7.

[ii] Naik AD, Kallen MA, Walder A, Street RL Jr. (2008 March 18). “Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.” Circulation, 117(11): 1361-8.

[iii] Tarn DM, Paterniti DA, Kravitz RL, Heritage J, Liu H, Kim S, Wenger NS. (August 2008). “How Much Time Does It Take to Prescribe a New Medication? Patient Education Counseling. 72(2): 311-319.

[iv] Frosch DL, June SG, Rendle KA, Tietbohl C, Elwyn G. (June 2012). “Authoritarian Physicians and Patients Fear of Being Labeled “Difficult” Among Key Obstacles to Shared Decision making.” Health Affairs, 31(5): 1030-38.

This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

There may come a time when your needs take you beyond your doctor’s abilities and he or she refers you to a specialist. According to the booklet, you may even request one yourself but you will need to check with your insurance plan for any requirements regarding referrals from your primary doctor. When you finally visit the specialist you should prepare to ask questions in the same way you would with your doctor.

The specialist should have already seen your medical records or test reports. While the booklet doesn’t say this I think a good specialist will ask questions first before discussing the diagnosis. I say this because there may be things the generalist misses or you may not have thought to disclose. I find it is also a safety feature so that they are diagnosing the patient they think they are meeting. Have you noticed that even in a regular appointment that each new nurse will ask the same questions that last one did and then the doctor usually asks them again? At least it seems to work that way in the big organizations. The small offices may not operate that way but when going to the specialist, one whom you have not visited before, they should be asking questions of you before any discussion of diagnosis.

When they start describing their diagnosis they will probably use terms that you are unfamiliar with. Ask them about the terms. Don’t be hesitant to say, “I don’t know much about that. What does that mean?” If you are still wondering, ask for materials or referrals to other sources for research. The booklet recommends that you have the specialist send material to your doctor. That allows him/her to be part of the discussion and keep track of your medical care.
Here are some questions you might ask your specialist:

• What is your diagnosis?
• What treatment do you recommend? How soon do I need to begin the new treatment?
• Will you discuss my care with my primary doctor?

Next: Things You May Experience When Talking with Your Doctor

This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

Do you search for information on the internet? It is a great resource but here are some questions to ask because not all information is reliable. The following questions may be useful to consider when you look at a health-related website.

• Who is responsible for the content? Is it a government agency, national nonprofit organization, or professional association? An individual? A commercial organization?
• If you are reading a particular article, what are the author’s credentials? Is the author affiliated with any major medical institutions?
• Who reviews the material? Is there a medical advisory board that reads the medical content before it is made available to the public?
• Are sources cited for the statistical information? For example, it’s easy enough to say “4 out of 5 doctors agree…” but where did that statistic come from?
• Is the purpose and goal of the sponsoring organization clearly stated?
• Is there a way to contact the sponsor for more information or to verify information presented?
• Is the site supported by public funds or donations? If it includes advertisements, are they separate from content?
• Because health information gets outdated so quickly, does the website post the source and date for the information?
• If you have to register, is it clear how your personal information will be used? Does the site have a clear privacy policy?
• Is the website trying to sell you something? Don’t forget to talk with your doctor about what you’ve learned online.

That last suggestion is very important…don’t forget to talk with your doctor about what you have learned!

Next article: Talking to Your Doctor in Special Situations

This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

In a sidebar on page 20 is this encouragement:

“Exercise is often “just what the doctor ordered!” Exercise can:

• Help you have more energy to do the things you want to do.
• Help maintain and improve your physical strength and fitness.
• Help improve mood and relieve depression.
• Help manage and prevent diseases like heart disease, diabetes, some types of cancer, osteoporosis, and disabilities as people grow older.
• Help improve your balance.

Many doctors now recommend that older people try to make physical activity a part of everyday life. When you are making your list of things to talk about with your doctor, Ask how exercise would benefit you, if there are any activities you should avoid, and whether your doctor can recommend any specific kinds of exercise.”

According to the National Institute on Aging they list all the above items with the incentive that exercise also helps you remain independent or less dependent on others. They go into more detail such as:

Four types of Activities – 1) those the build endurance, 2) build strength, 3) maintain balance and 4) maintain or build flexibility.

You may want to visit their website: http://www.nia.nih.gov/health/publication/exercise-and-physical-activity

Next article: Evaluating Health Information on the Internet.

This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

Once you have established good communication, the kind that involves not only getting information but also giving it, you will need to work with your doctor on a plan of action.

Keeping in mind the two way communication…

Ask about different treatments.

Whether it is medication or surgery you will need to ask questions. Let’s say that your doctor is prescribing medication for diabetes. Ask, “What are the pro and cons of the medication?” “Do I have any other choices besides this or any medication?” The same questions are good for the surgery. Most doctors will probably be discussing this with you anyway but in the event they don’t you need to ask. If you are uncomfortable with the treatment prescribed then practicing good communication, you need to let your doctor know that.

Here is a summary of ideas to help with your discussion:

Ask about different treatments:

• Are there any risks associated with the treatment?
• How soon should treatment start?
• How long will it last?
• Are there other treatments available?
• How much will the treatment cost?
• Will my insurance cover it?

Ask about prevention:

• Is there any way to prevent a condition that runs in my family—before it affects me?
• Are there ways to keep my condition from getting worse?
• How will making a change in my habits help me?
• Are there any risks in making this change?
• Are there support groups or community services that might help me?

Next article: Speaking of Exercise