frustrated doctor

Doctors are impatient. We understand why. They are being pushed by office managers to see more patients in less time. That means they often feel like hamsters on a treadmill. In fact, some physicians have taken to calling this treadmill medicine. One result is that many doctors interrupt patients before they have a chance to tell their whole story. What are the ramifications of 11-second interruptions?

Interrupting Patients Is Nothing New:

Over 30 years ago a landmark study published in the Annals of Internal Medicine (Nov. 1984) reported that on average, physicians interrupted their patients after only 18 seconds. The authors noted:

“Determining the patient’s major reasons for seeking care is of critical importance in a successful medical encounter. To study the physician’s role in soliciting and developing the patient’s concerns at the outset of a clinical encounter, 74 office visits were recorded. In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement of concerns. In 51 (69%) of the visits the physician interrupted the patient’s statement and directed questions toward a specific concern; in only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement…The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.”

Fast Forward to 2001:

A study of medical residents behavior published in Family Medicine (July-August, 2001) reported that:

“Patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room.”

The 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.”

You may not be surprised to learn that “Female residents interrupted their patients less often than did male physicians.”

It wasn’t just the doctor interrupting the patient. The researchers noted:

“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.”

Are You Tired of Doctors and Computers?

We were glad that the researchers noted that doctors typing on computers also interfered with communication. But keep in mind that was published in 2001. In those days doctors did not have to use computers. Now, virtually all doctors have to use a computer to enter patient information into the electronic medical record. We think that this can be a tremendous impediment to good communication.

The 2018 Update on How Doctors Interrupt Patients:

A study published in the Journal of General Internal Medicine (online, July 2, 2018) assessed 112 doctor-patient interactions between 2008 and 2015.

The researchers report that:

“the clinician interrupted the patient after a median of 11 seconds.”

That’s right, 11 seconds! Imagine trying to describe to your lawyer a serious legal matter in 11 seconds. Isn’t a medical problem at least as important as a legal problem?

Why Are Interruptions Bad Medicine?

The authors of the new study introduce their research this way:

“The medical interview is a pillar of medicine. It allows patients and clinicians to build a relationship. Ideally, this process is inherently therapeutic, allowing the clinician to convey compassion, and be responsive to the needs of each patient. Eliciting and understanding the patient’s agenda enhances and facilitates patient-clinician communication.”

The authors note that the results of their study demonstrated that:

“patients are given just a few seconds to tell their story.”

If patients are not interrupted, they normally complete their story in 92 seconds. That seems totally reasonable. Yet few physicians can sit patiently and wait for a minute and a half while a patient describes why they have come to the doctor’s office.

Specialists Were the Worst:

Specialists were less likely to ask patients about their concerns and agenda than primary care doctors.

The authors conclude:

“the results of our study suggest that we are far from achieving patient-centered care, as barriers for adequate communication and partnership continue to limit the elicitation of the patient’s agenda and lead to quick interruptions of the patient discourse.”

That’s a diplomatic way of saying doctors interrupt patients far too often and far too quickly. We suspect that most physicians would be upset if patients interrupted them after only 11 seconds.

We do understand that doctors are being pushed harder and harder. Time constraints are burning out a lot of well-meaning physicians. But that is no excuse for interrupting a patient after only 11 seconds.

What Do You Think?

Share your perspective in the comment section below. We would LOVE to hear from physicians, nurses and other health professionals.

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  1. Joyce
    Missouri
    Reply

    It has been my recent experience that doctors can address only one issue per visit. Extremely annoying. A few doctors have someone else type the medical information which is very helpful.

  2. SARA
    Fayetteville, NC
    Reply

    Helen, have you noticed how little Medicare approves, then how little it actually pays! I guess that is why doctors and medical facilities have to charge such high fees and costs; they do not get paid very much by Medicare, and probably other insurances, too. Medicare should be required to pay a reasonable amount to our medical providers and medical care facilities!!!

  3. Linda
    Toledo Ohio
    Reply

    Hi, if we think back to the 1960-70’s, we received medical care and attention. That changed when insurance companies started contracting with physicians. I worked for the insurance companies. They convinced doctors to join their Network, receive $ for all patients who picked them as their PCP, without having to see the patient. If the doctor actually saw the patient, they received the copayment in addition to the monthly payment, all the while telling the doctor, they would not dictate how to practice medicine. That morphed into a money making, big business machine. The “old” GP” knows this, but family practice doctors are “raised” in the matter of business. Get them in, get them out. The only way this will change is when we the people/patient says, “enough!”. And how about our having to pay a Specialist copay, but are seen by a CNP or a PA? Try asking that person what the doctor’s opinion of their health concerns are. The physician hasn’t seen, reviewed or discussed your treatment with the CNP or PA. These are less schooled people, who may be fine for minor complaints. Not so for many health issues.

    We are just a number and money maker to the insurance companies, and some doctors.

    Pharmaceutical companies are worse. That’s why I subscribe to the People’s Pharmacy.

  4. Abigail
    U.S.
    Reply

    My escellent doctor retired . Her replacement misdiagnosed new health problems twice because she did not ask enough questions to get a correct diagnosis. I am fortunate to have knowledge of anatomy and physiology and of my own body . I stopped the prescribed treatments before damage was done. .

    Other members of a health team such as Physicians Assistants and Physical Therapists can be goiggaiod sources for doctor references . They see the results.

  5. Sherry
    GA
    Reply

    I’m so glad my doctor does not use his computer. I have to wait when I see him because he takes what ever time is needed with his patients. He is a wonderful doctor

  6. Catherine
    Sandwich IL
    Reply

    In March 2017 I ended up completely blind. The abbreviated story of this is I have had multiple sclerosis for 40+ years. I first went to a doctor in my early 20s and was told it was psychosomatic. In my late 20s, I saw a doctor for new leg symptoms and was told nothing was wrong. In my late 40s I had symptoms of vertigo and saw a physician and was told it would go away in 3 months. A few years after that, as my balance was still off, I saw an ENT physician who told me he had seen worse. So when my sight started to go, I thought it was just something I had to live with.

    As my vision worsened, I saw a PCP, then an ophthalmologist who said I had a stroke, and my PCP told me to take an aspirin, and I was sent home. Two days later I was completely blind and admitted to the hospital. My sight came back so that at 9 weeks into this I was able to read the internet and searched optic neuritis and saw that it was almost always MS relate. I got a copy of my MRI, and that is when I knew, since I had brain lesions. It took another year of testing, and finally lumbar puncture confirmed what was shown on initial MRI and symptoms. I never had a stroke.

    If any of them had watched my gait, they could have saved those 11 seconds of listening.

  7. Pat
    Washington
    Reply

    It behooves a patient to take a list of symptoms and a list of questions to their Dr.’s visit. Friendly chit chat makes us feel like the Dr. is our friend and confidant, but it’s time consuming. First things first then smooze if you want and there’s time.

  8. DENNIS
    DELAVAN, WI
    Reply

    I have tried this with some success. I took a list of concerns to the Dr. visit–two copies. One for the Dr., and one for me to refer to during the visit.

    It has worked for me. If some issues are missed, they can be revisited before walking out of the office, or a complaint cane made before the Dr. leaves you.

  9. Nancy
    West Windsor, NJ
    Reply

    My advice: Use a reporter’s notepad (receives attention and indicates that you are a professional in another field.) Organize your questions. Be prepared to speak “Medical-ese.”

    Also, the patient usually has an idea of what might be their issue (speak up!) Encourage
    the doctor to want to care for you, he/she is a person, too, under pressure. “Why” is
    a necessity here. Don’t be dependent. He/She is a co-worker, a “team” so to speak,
    to get you well, keep you well;otherwise, they wouldn’t have gone thru 4 years of Med
    School + Residency.

  10. Sue M
    WA
    Reply

    I have lived in 9 different states. The best doctors in the world and I will shout from the rooftop! WA /OR

    I have a wonderful Cardiologist and Pulmonologist that usually spend 25+ mins. with me. Listening to me completely-Asking me questions and if I understand what they are telling me. He/she address each and every question. Very personal and yet very professional the perfect formula!
    But… Don’t be all over the place. Get to the point. If you have to make a list do so. I had one doctor tell me I am in a small % of patients that will do exactly as they say. Find another doctor until you are happy! Your choice!

  11. Kaye
    NC
    Reply

    After reading all of these comments, I would like to inject a little piece of humor here if I may. When I first met with the GP I have now known for over 25 years, I shared that he and I needed to know two things: First, how old was he? The look on his face led me to share that I was not looking to date him; that I just wanted to be sure he was young enough to continue to be in practice when I hit 80, and I wouldn’t have to seek another GP at that point. The second thing was when I came to him and said I was sick or hurting to never second guess me; that I would not be in his office on any other occasion.

    In fact, I was in his office for a “well check” and asked for a bandaid, as the one I had on had lost the stickiness. He looked at the injury, a small cut on my wrist.”That needs stitches,” he replied….pointing out it was in the bend of my wrist and would take forever to fully heal. Ended up with five stitches that day. Before I left, I shared that if I hadn’t needed a bandaid he would never have known. He smiled and responded “I know”. As you can see, I was really fortunate to find this man and appreciate his care, concern and attention…and his sense of humor.

    I do emphathize with those of you who have not been as fortunate but it is your body, your life, and stand your ground.

  12. Florence
    NORTH CAROLINA
    Reply

    It’s surprising to me how so many in the ultimate people business (medicine) have few people skills. I think most patients want physicians who have a love of both physiology and people. There’s much wrong with our healthcare system, and it’s discouraging that at its core are those who have one of the the highest IQs of all the professions.

  13. Helen
    Maryborough Qld
    Reply

    Consultations cost money. They also earn the Dr. income,often from Medicare. When they badly type consultation notes with one finger, we are paying for this extra time. Why does Medicare allow this to happen? The Dr should write his comments, and notes, after the consultation. Why do we pay for this time? It is not part of the consultation.

    • SARA
      Fayetteville, NC
      Reply

      Helen, have you noticed how little Medicare approves, then how little it actually pays! I guess that is why doctors and medical facilities have to charge such high fees and costs; they do not get paid very much by Medicare, and probably other insurances, too. Medicare should be required to pay a reasonable amount to our medical providers and medical care facilities!!!

  14. Pat
    Santa Rosa California
    Reply

    I, too, am always interrupted by someone coming in when I have a doctor’s appointment.

  15. Liza
    El Paso TX
    Reply

    I pretty much feel the same as the others listed above. I also think I am a victim of the new practice of medicine by talking and not touching. When I discuss my legs or my arm they just wrtie and say they can give me a medication. They don’t examine my body or the appropriate extremity. The only touch is listen to the apical pulse for definitely less than a minute and the back on either side (2x) for the lungs (“take a deep breath”).

    Also I always get seen by a PA in my doctor’s office, and it could be a month and a half to get a doctor’s appointment. I have never seen a doctor in this office. And of course, as you mention – interruption and computer time is first!

  16. mary
    IN
    Reply

    there are the usual interruptions [for the 15 min. visit i am granted]. usually get the questions answered on my list before i leave my internist. also on my 6mo. dermatologist visit recently he SAW ME FOR 5 MIN> and i was out. how dare he chg medicare for that visit !!

  17. Jae G
    Arizona
    Reply

    On first appointments, I matter of factly, with good humor, advise doctors that they are either going to love me or hate me because I am a vocal advocate in regard to my health and expect an active partnership with them in all aspects of my care and treatment.
    That said up front cuts right to the chase and I have yet to have a doctor take offense to it, or treat me with anything other than respect as a result of it.

    I take notes to my appointments and at my appointments, keeping track of what I have to and do tell the doctor and what the doctor tells me in return. This saves time and confusion for us both while helping foster that doctor/patient partnership.

  18. Hil
    Devon,UK
    Reply

    I have been a nurse, midwife and counsellor in the UK NHS since 1979 and sympathise with the time pressure experienced by doctors, but I’ve also been on the receiving end of bad practice by doctors impatient and uncaring. My new GP, in an initial appointment, completely dismissed my major problems, consequently delaying my referral to a consultant and for a major operation for 7 months as he didn’t listen!

    This was also despite being offered the operation in another district 3 months before, so he also could have checked the notes which he obviously didn’t. He’s since gone on to do a medical report on me and said I have no medical problems, although I have diabetes, arthritis, fibromyalgia and other concerns!

    No wonder the public have little confidence in doctors now! I think doctors should all have counselling or listening training and refreshers yearly.

  19. Jan S
    North Carolina
    Reply

    I’ve experienced the same issues. I told my GI doc I thought I had a hiatal hernia, as my symptoms were the same as my mother’s, who did have a hernia. He blew me off and said I just had reflux and to take Pantoprazole. I did what he said but when I started reading your newsletters about all the bad side effects of PPI’s I phased it out and tried many alternative things I read about on your site and others. They work most of the time.

    Fast forward two years and when I just scheduled my routine 5-year colonoscopy, I asked to also do an endoscopy to check that area. When I told him I had phased out the Pantoprazole he cut me off and said I was a therapeutic nihilist! I told him I happily took my blood pressure med but was afraid of long term with PPI’s, he again cut me off and left the room. Geez!! I’m an educated, reasonable person, but I think doctors hate those of us who educate ourselves about our issues and ask reasonable questions.

  20. Helen
    NC
    Reply

    I agree 100%. Or they spend too much time typing on their computers. You are the patient and they should not spend time messing with the computer when they should be talking with you as to what is going on with your health. I have had this happen to me so many times that I just stopped talking and told the doctor when he’s done if the computer then I can talk to him. Don’t think he was happy with that answer but I’m the patient and the computer can wait. So many times doctors don’t seem to be interested and what you have to say and just kind of turn you off. That is not a professional way to be the doctor.

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