If the doctor is listening, you have 11 seconds

After a doctor poses a question — such as "What brings you here today?" — patients get a median time of 11 seconds to answer before the doctor interrupts them, according to the findings of a new U.S. study.

That quick interjection while the patient is speaking worries Dr. Naykky Singh Ospina, a Florida physician specializing in internal medicine who is interested in making interactions with doctors more patient centred.

"Patients want to be asked directly why they are here and that is essential," she said in an interview with CBC News.

From the patient perspective, they want to feel comfortable that the physician is there to help. They won't feel that if they're not being heard.- Dr. Naykky Singh Ospina, University of Florida

Especially with patients with multiple medical problems, an open-ended question such as "How are you?" or "What brings you here?" can bring out more detailed information, she said, and doctors should be listening to the answer.

"From the patient perspective, they want to feel comfortable that the physician is there to help. They won't feel that if they're not being heard," she said.

Research published in the Journal of General Internal Medicine suggests only one in three doctors even asked the patient what they think they'd like to get out of the visit.

Singh Ospina, a faculty member in health endocrinology at the University of Florida, analyzed 112 recordings of doctor-patient visits at various clinics and practices in Wisconsin and Minnesota to reach her conclusions.

Family doctors better listeners

Family practitioners were better at letting their patients present their own agendas, with half of them beginning the visit with an open-ended question. Then they let the patient speak an average of 19 seconds.

Only 20 per cent of specialists started with an open-ended question, then they interrupted more quickly. Singh Ospina hypothesizes the specialists may skip the introductory chat because they already have notes on why the patient has been referred.

Still, they may be missing parts of the story, she said.

"When you leave patients to tell their story, it takes two minutes at the most," she said.

Patients who were feeling well or had no problems stopped talking in a median time of six seconds, the study found.  

Sometimes, the doctor interrupts to get clarity from a patient or to focus the conversation, but 11 seconds is still too soon, Singh Ospina says.

The doctors assumed they knew why the patient was there, she said. One limitation of the study was that some of the patients were involved in clinical trials, in which doctors were doing followup.

Doctors may have too little time

But doctors still should not assume they know everything that is happening with a patient's health, Singh Ospina said.

She suggested some reasons doctors may spend so little time listening:

• Time constraints.
• Not enough training on how to communicate with patients.
• Physician burnout.
• Concentrating on electronic records, instead of interaction with the patient.

Singh Ospina says meaningful conversation lays the foundation for making care patient centred and she wants to know why doctors are not engaging fully.

"It's an area we want to do more study," she said.

"There is a lot of emphasis on communication in medical school. There is a disconnect between what they learned about patient-centred care and the clinical practice," she said.

In Canada, the same problem

Dr. Arno Kumagai, chair in humanism education at the University of Toronto medical school, says medical students do learn the importance of communicating with patients, but the culture of medicine tends to work against it, in Canada as well as the U.S.

"In general ... there is a movement toward teaching medical students to seek patient preferences, values and perspectives. It happens in the first two years, but it drops off when they get into wards or the work environments."

Many studies bear out Singh Ospina's findings that doctors do very little listening in a clinical setting, he said.

"Often the doctor has in mind he's trying to get the patient to stop smoking and they want to talk about their grief over their spouse who died a few months ago," he said.

The fee-for-service model, in which doctors bill for each patient seen, encourages a rushed culture, Kumagai said.

And electronic records, in which a doctor must look at the screen to fill out a form instead of the patient in the chair, can also shift the focus of a visit, he said.

"It can be taught, but if it's not active in the culture, it gets dropped," he said, adding that the medical profession should be looking for ways to encourage a patient-centred culture, despite the confines and pressures on doctors.