Time's Up on The Ten Minute MD Appointment

If you think your G-P has little time for're not alone. Many doctors see patients in eight to ten minute appointment slots. Critics say brevity leads many MDs to do most of the talking during appointments. I say it's high time for a different approach.B

It's becoming increasingly obvious that health care providers need to talk to patients less and listen a lot more.  A famous study looked at the lack of exchange between doctors and patients during office appointments.  The study measured the time spent by patients talking about their symptoms.  After first asking the patient "What's wrong with you?" or "How can I help you today?" on average, the doctor would let the patient talk for just eighteen seconds before interrupting the patient with another question.  Grab a stopwatch and try telling something important or worrying in eighteen seconds.  I'd give anyone a medal that pulls that one off.

How do you fix that? For one thing, instead of assuming that health care providers are good communicators to begin with, as reported recently in the NY Times, the director of a health system in Harrisburg, Pennsylvania did a baseline assessment of doctors to see how well they communicated with patients.  They found rushed appointments with little time for patients to talk and little empathy from the doctor.  Then, they developed a training program in which the doctors did mock interviews with actors playing patients.  Doctor-coaches also sat in on interviews with real patients.  In part, they learned to mind their p's and q's.  They also learned how to listen carefully to the patient, and to keep checking with the patient to make sure they were getting the patient's symptoms right.  Not surprisingly, that takes time - much more than ten minutes. There's a movement to get away from the rush.  It's called slow medicine after the more familiar slow cooking.

The benefits of slow medicine are potentially huge. Pinnacle Health System in Harrisburg, Pennsylvania trained MDs in communication skills, and saw the hospital's overall patient satisfaction score go up by a remarkable forty percentile points. In other words, it leapfrogged over forty percent of the hospitals in America.  But this is about much more than patient satisfaction.  Studies have shown that the less time the doctor spends with the patient the more likely the doctor is to make the wrong diagnosis.  Diagnostic errors are the leading cause of malpractice and related lawsuits.  Real examples reported in the US include mistaking a ruptured tubal pregnancy for appendicitis, and mistaking a stroke causing vertigo for a middle ear problem.  Studies have shown that diagnostic errors are often lethal.

If slow medicine is safer and more accurate, why are doctors in such a hurry? The answer is complicated.  As strange as this sounds, traditionally, we pay doctors a lot more money to do things like procedures and operations than we pay them to listen to patients.  As I say this, I have no doubt that some doctors are screaming at their radios that the system is moving away from fee for service in health care.  That is true, but the damage done by fee for service can't be undone.  You can get rid of fee for service, but that doesn't take away the belief held by some doctors that ten minutes with the patient is enough.  In the culture of medicine, doctors hope that diagnostic tests and CT scans can make up for not having time to listen to the patient.  Believe me, it can't. 

Critics (among them, many physicians) may not say this publicly, but privately, they say that if the provinces want MDs to spend a hour with the patient, they need to recruit and train more doctors because there aren't enough hours in the day to give every patient they hour they need.  The provinces also need to pay doctors a lot more per patient than they do now. Perhaps one solution is for someone else on the health care team (for example, a health coach) to spend that extra time with the patient and to fill the doctor in so they're up to speed.  And even with more time per patient, some diagnostic errors are inevitable.  Still, I think all of us need to slow down.


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