Speaking and interruptions during primary care office visits

I have been exchanging emails with a fellow blogger from the Planet Autism. We share similar complaints in regards to the medical system. I plan to write some of the bits and pieces of interesting information from our exchange in a future blog about the so-called “Precision Medicine” initiative –including some of the negatives this may bring about. At present, however, I would like to provide an abstract summarizing a disturbing aspect of medical practice. It has been said since the times of Hippocrates that diagnosis is usually revealed in the patient’s history. This requires good communication between doctor and patient. Physical examination and laboratory tests in this regard are often incidental maneuvers geared towards corroborating the suspicions raised during history taking.

It is said that medicine became part of the Age of Enlightenment when the body was mapped and rules as to the classification of diseases were established. In this regard medicine became a science just as mathematics. I do believe that this unfortunate trend separated patients and their complaints from cultural and social attitudes. The “Art” of medicine is slowing making an exit, a trend that has ultimately fostered a dehumanizing effect in medicine (see my previous blog: http://bit.ly/1EO3yLL ).

For those interested in the following abstract you may find more information about the same at: http://bit.ly/16Ecx3p and http://bit.ly/17HXXJ4 The reference for this abstract (which can be obtained through Pubmed) is Rhoades DR et al. Fam Med. 2001 Jul-Aug;33(7):528-32.

Abstract
BACKGROUND:
Patients and physicians value effective communication and consider it an essential part of the medical encounter. This study examined physician-patient communication patterns, and interruptions in communication, during patient visits with family practice and internal medicine residents.

METHODS:
Observational data obtained from 60 routine primary care office visits included the time that resident physicians and patients spoke and the number and types of interruptions. A total of 22 family practice and internal medicine residents participated, 9 from family practice and 13 from internal medicine.

RESULTS:
Patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room. One fourth of the time, residents interrupted patients before they finished speaking. Residents averaged interrupting patients twice during a visit. The time with patients averaged 11 minutes, with the patient speaking for about 4 minutes. Computer use during the office visit accounted for more interruptions than beepers. Verbal interruptions, a knock on the door, beeper interruptions, and computer use all interfered with communication, and increased frequency of interruptions are associated with less favorable patient perceptions of the office visit. Female residents interrupted their patients less often than did male physicians. All residents interrupted female patients more often than male patients. Early and increased interruptions were associated with patients’ perception that they should have talked more. Third-year residents interrupted patients less frequently than did first-year residents.

CONCLUSIONS:
Numerous interruptions occurred during office visits. Gender was associated with the pattern of interruptions. Physicians frequently interrupted patients before the patients were finished speaking. Computer use also interrupted physician-patient communication.

page1-776px-History_Taking.pdf
Figure illustrates all of the details involved in History Taking.

3 responses to “Speaking and interruptions during primary care office visits

  1. Face to face communication, active listening and a calm presence facilitates a more effective doctor, patient relationship. Often, the doctor is more focused upon entering data into the computer than in listening and facilitating communication with the patient. In the past I’ve prepared a list of symptoms, handed it to my doctor, who immediately turned away to type in my symptoms, asking further questions with her back to me. I believe that a redesign in the environment for an improved patient/doctor relationship would improve appointments and results. I suggested to my doctor that she mount the computer upon a movable arm so she could look at me.

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    • Soon patient’s histories will be replaced with laboratory values. It is a pity that so much of research money and diverted from essential pursuits. I will probably post a blog Monday about Precision Medicine and what can we expect from it. Thanks for your comments.

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