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.
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.
- 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.