A recent article evaluated 112 recorded clinical encounters. The rationale was testing of “shared decision-making tools.” I was confused by the findings and conclusions.
In 27 of the 40 (67%) encounters in which clinicians elicited patient concerns, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7–22; range 3 to 234 s). Uninterrupted patients took a median of 6 s (interquartile range 3–19; range 2 to 108 s) to state their concern.
The headline adopted by the media was that physicians interrupt patients quickly. It was not intended as praise.
Interrupting may or may not be helpful in solving the problem at hand.
If the patient wants to meander for 5 minutes including details of no import to making a diagnosis, then why not interrupt? This issue is even more challenging when an office has booked patients solid and time is the single commodity in scarce supply. Further, third party payers and healthcare employers are pushing doctors to see more patients in shorter time slots. So, if one cannot get to the point quickly, no one benefits. The only obvious benefit to the meandering history would be the patient does not feel rushed; admittedly an important perk, but paling in significance to accuracy.
All professionals interrupt. It’s called asking questions. Lawyers interrupt. Accountants interrupt. It’s because they are developing an evolving hypothesis in their mind to solve the perceived problem at hand and are looking for confirming or refuting data. Plumbers and electricians do the same.
While I’m all for a relaxed doctor-patient encounter where there is unlimited time to have a back and forth discussion, there are other factors at play. Unless and until it is clear that the interruptions lead to less accurate diagnoses or failure to identify and solve problems, let’s call it something else: Questioning.
What do you think?
You want to practice good medicine with peace of mind. We want to help.
Contact us to learn how we help.