Tuesday, June 26, 2007

Researchers to Docs: Shut Up!

In the past, physicians have been criticized for not spending enough time with their patients. In fact, many alternative and complementary medicine websites have used this research to promote themselves.

Alternative medicine has quietly jumped into the mainstream. By 1993, one in three people have used at least one alternative therapy and $14 billion was spent on those therapies according to the New England Journal of Medicine. Half of all U.S. medical schools teach about mind-body connections; alternative medicine is now offered at Georgetown and Columbia University.

Why the surge in interest? Many Americans find alternative approaches to be less expensive, with fewer side effects. Some feel that modern medicine is blind to the connection between mind and body. For others, the human touch is the real appeal. According to one source, the average doctor interrupts his patient 12 to 14 seconds after the patient starts talking. It is hard to feel cared about in that kind of environment. The alternative practitioners tend to spend time with their clients and actually listen to them.
Well, now there is research published in the Archives of Internal Medicine stating that physicians are "wasting" time of patients by talking about themselves during office visits (WebMD).
Researchers sent a group of actors posing as new patients to primary care doctors and found a third of doctors made unprompted comments about their own health, personal life, or political views. The vast majority of those comments (85 percent) weren't viewed as useful or relevant to the patient.

While a good bedside manner is important, researchers say that in an era of ever-shortening office visits doctors should keep the conversation focused on the patient.

"We found that physician self-disclosures were often non sequiturs, unattached to any discussion in the visit, and focused more on the physician's than the patients' needs," write researcher Susan H. McDaniel, PhD, of the University of Rochester School of Medicine and Dentistry, and colleagues in the Archives of Internal Medicine.

"Longer disclosures, both not useful and disruptive, interrupted the flow of information exchange and expended valuable patient time in the typically time-pressured primary care visit," they write.
This study is actually kind of funny to me. I like to establish a rapport with my patients, and that sometimes means talking about me. The "time-pressured primary care visit" phrase particularly strikes me as funny.

I believe at the core of Family Medicine is relationships - relationships with my patient and relationships with my patient's family. I admit that sometimes the banter I have with patients may not directly relate to their medical visit, but I still think it's good medicine - despite what these researchers say.


Anonymous said...

I like it when my doc talks to me about stuff....it makes him feel more human to me. Not that doctors are robots or anything, but some are just so quick, in and out, like they don't care. While most of our off topic conversations deal with food...because my husband and I often bump into my doc and his wife out eating....I still get my patient needs met. Even before I knew him well...it was still nice to hear bits and pieces of his life, cause he is after all, a person, with a life....not a robot that fixes people and has no emotions.

twilite said...

Hi Dr A! Disturbing indeed. I thought docs don't talk much with their patients...as a matter of fact, patients love it when docs DO talk! Great write! Kudo.

"Please DON'T shut up Doc!"

Chrysalis said...

I agree with you here Dr. A.. I like when my doc. talks to me too. It makes me feel like I know him better, and he in turn knows me better. It's been a blessing.

When I went to him with strange symptoms, he knew from prior exchanges with me to listen,that I never came to him for frivolous annoyances. From knowing this about me, he was able to diagnose the rare tumor - I've since had removed. Someone who didn't know me well, may have thought things were "stress" related.

ha, my word verification is Moofy..love that!

Cory said...

My favorite doctors have always been the ones that talked to me. It's usually about stuff that gleans them information about my condition, but it isn't always direct questions either. Like asking me about work, or mentioning that they are following a similar exercise routine to mine.
My last family doctor never did that, and I wasn't always so comfortable telling him about things. But my favorite doctor is my back specialist and she always makes a point of asking about my life, and remembering things.

Bongi said...

today i spent about ten minutes chatting to one of my patients about his farm and the fact that he had to sort out a hippo problem (yes you heard me) and i'm a surgeon. dam i'd be a good alternative healer.

Your Mother said...

Not reading the study itself, of course, I can only conjecture, but what's interesting to me is the psychology of an actor in these situations vs. that of a real patient (and how much, if at all, this was accounted for in the study).

To an actor who doesn't feel ill or doesn't identify personally with the "illness," a doctor's personal anecdote may seem more jarring than to a patient who is sick and anxious and eager to identify on any level with the doctor he hopes can help him. (Responding to the article's statement: "The vast majority of those comments (85 percent) weren't viewed as useful or relevant to the patient.")

Not to mention that, just because a study subject, when queried, admits that a comment wasn't strictly "useful or relevant" doesn't mean that he or she didn't enjoy the interaction more than one in which no personal banter was provided. In fact, I didn't see that any comparison (to a control) in the study at all. Maybe I missed something.

Also disturbing:

In the study, researchers analyzed the transcripts of 113 visits between the actors posing as new patients and 100 primary care providers.

The results showed doctors talked about themselves in about 34 percent of the visits ...

Only 10 percent of these self-disclosures were in response to a patient's question ...

"Only three physician self-disclosures (4 percent) were coded as useful ... " write the researchers.

I mean, who cares how the researchers codify it? What matters is how the patient feels (discounting the fact that he's only acting and doesn't really care, unless he once had the ailment he's faking, then perhaps he's a little more vested in the interaction).

In addition, 11 percent of the personal chitchat was considered disruptive ...

Considered by whom? By the patient/actor? By the researchers?

Gotta be careful when you read these studies, especially when filtered by the news!

Anonymous said...

I know from my years in the healthcare business, establlishing physician-patient rapport is a great way to ensure the patient "buys in" and remains an active participant in their own healthcare. (sorry for the long run-on sentence)

I'm a social person, so I would react better to a provider who seems more "personable" to me. Perhaps someone less social would prefer someone who merely stuck to business. I think it all boils down to the meshing of two personality types.

What do y'all think?

Your Mother said...

I'm a social person, so I would react better to a provider who seems more "personable" to me.

I'm a shy person, and I appreciate a personable (even chatty) interaction, too.

It's interesting. I always assumed that social people minded colder interactions less, because they (the social ones) can provide the banter. In other words, I thought a shy person minded the coldness more (than a social person). Interesting!

Irene said...

I like my doctors open and chatty.

So please don't shut up! ;p

XE said...

I like doctors who talk about normal stuff --- it makes them seem more like me, you know?

Anonymous said...

I too, have noticed that a lot of doctors will talk about other things besides what is bothering me when I really just need to talk about my health. Thanks for the article!

Mimi Lenox said...

Anything that makes a patient more comfortable is great. We would all love to have a doctor who acts human and is compassionate. But I'm not surprised you are in that category. Great post.

Anonymous said...

Dr. A ... without that sort of "chatter," I'm afraid that I would never ever unwind ...

However, I think that it's probably different for each person ... and a physician who is tuned in would probably be able to tell which patients appreciate it the most.

Excellent post, Dr. A!

C. Angel ... *eep!* Is there a Moof caught in the Blogger gears? ;o)

Ami said...

If I can't develop a rapport with my doctor within 5 minutes of the first visit, I don't go back. I *have* to have a connection to that person. Why would I trust my life or the lives of my children to someone I can't communicate with? Funny, I just saw my doctor today. This is the first time we haven't had a conversation, since I'm not talking until the strep clears up a bit.

Anonymous said...

Interesting...my GP is personable but I have only been seeing her for a while so we have yet to build up a rapport. Apart from the regular 15min. appointments, she also offers 30min. appts. for more serious counselling. This to me is interesting.

She doesn't interrupt me. She lets me say whatever I want. And however I want to...I can get as angry and frustrated as I want and she doesn't bat an eyelash. She just listens calmly and sometimes even laughs or cracks a smile. Sometimes we laugh together.

My gastroenterologist appts. basically go like this. He asks me how I'm doing, I let him know. Based upon that he gives me his opinion and course of action/plan. He then he asks me if I have any questions. I do my own medical song and dance of course, ask lots of questions to ensure that this in fact is the right course of action and that we are both in agreement.

My new psychiatrist--because he's new--asks me lots of questions! That's because we are just embarking on our relationship. And psychiatry is different. They need to be very probative because if I come in all doom and gloom with my face around my ankles, I'm not going to open up anyway. But things are looking good there because I know my meds and he's all jiffy cool with that so we just sit around and talk meds, meds, meds! We're still tweaking my cocktail and later we'll probably get into some deeper stuff.

My neurologist. He interrupts me. And I schlep my butt quite far to see him for about 5min. I don't particularly like him but he "fixed" my seizures and I still need to follow up with him.

Okay, that was kind of long but I obviously have a lot of doctors?

Ajit said...

I fully agree with you when it comes to building a rapport with your patients. As good clinicians one can come to a fair amount of conclusion about the patients problem,as he is entering the doctors chamber and in the first few interactions.Many a times the patient does not require any medication .He just wants a sympathetic and patient listening to .

In my practice I see that I give enough time listening and talking to them apart from the clinical examination and diagnosis.A person coming in my chamber has always left smiling and satisfied . That is why I have quoted on my blog that the feed back from patients is " We feel good,just talking to you " This is possible in a family practice as consultants in hospitals rarely have any attachment to the patient and his family.It is a more robotic approach.