Scenario 1: You’re in the exam room, sitting in an open-backed gown. You and your doctor have discussed your high blood pressure (stay on the same medication) and your diet (you reluctantly agree that you need to try to make healthier choices to control cholesterol). Your doctor makes a note on the computer screen, jumps up, and heads to the door. With a hand on the doorknob and a “see you next year,” your doctor is about to disappear. Bam! Out the door!
“Wait,” you say. “I have more questions.” But your six-minute visit is over, and you never mentioned the blood in your stool, and you meant to ask about the funny mole on your back.
Scenario 2: You’re in the exam room, sitting in an open-backed gown. Your blood pressure taken, and the doctor looks at the lab work and decides to up your dose of heart medicine. And the doctor says, “And you might take a baby aspirin every day.”
“A baby aspirin?” you ask. “Why?”
“It thins the blood and might lower your stroke risk,” replies the doctor who has a hand on the doorknob to exit.
“What is my risk for stroke?” you ask. “Am I at risk for stroke?”
“We all are,” the doctors says as the door slams behind him.
Unanswered questions. Missed opportunities. Short visits. No explanations forthcoming. What’s wrong with some healthcare providers and doctors today? Why won’t your doctor listen to you?
Does any of this sound familiar?
The Disintegration of Medical Practice
Medicine is at the crossroads of disintegration in the delivery of clinical care despite incomprehensible advances in surgery and in the management of conditions that were once deemed to be hopeless and fatal. Some patients with stage IV far advanced cancer can be cured by designer drugs and precision medicine. The revolution in robotics and in laparoscopic technologies has transformed surgical management of some conditions.
Nevertheless, there is a crescendo of frustrations and criticisms by patients seeking care.
So where do we go from here?
Imagine a bunch of invisible partners in the exam room with you. One is the behemoth insurance company. With their stopwatch monitoring the length of each visit, you’ll be lucky to get your average six minutes.
At the same time, your provider is being pressured to see more patients, like Lucy and Ethel in the chocolate factory trying to keep the conveyor line moving. Add to that the burden of the electronic medical record where the doctor is required to do all kinds of technological acrobatics to get your health information into the system. Doctors often spend more time in front of a computer than in front of the patient. Didn’t use to be that way.
And who among us healthcare providers has the residual bandwidth to meaningfully engage with concerned patients and families in view of this digital dragon siphoning off doctors’ time and energy?
I have seen data that in a ten-hour shift in the ER, the emergency physician will perform over 4,000 mouse clicks.
At the end of a typical month, a primary care physician will have contributed up to 25 hours of personal and private time on the computer. Some medical offices are now charging patients to respond to email questions especially if those questions involve reviewing the medical record to prescribe medication.
The explosive, almost cataclysmic increase in medical knowledge is another factor taking away your doctor’s time and attention. The body of medical knowledge is doubling almost every 70 days, and in some circumstances, the engaged patient will have more factual knowledge about their illness than does the provider—thanks to information-rich patient portals and medical databases open to anyone who cares to ask Mr. Google.
The burned-out physician is more typical today than in the past when the friendly family doc made house calls and took a chicken in payment.
The New Reality in the Exam Room
Is your doctor hustling you through the exam? Yes. Does your doctor care about you? Probably. But circumstances don’t allow the doctor to do what doctors do best and that’s listen to the patient and make thoughtful decisions about care. I am referring to what is called decision fatigue.
Doctors are tired. Their fatigue is spiraling out of control. They are burned out. Colleagues are leaving the profession. Retiring early. Moving on.
Decision fatigue doesn’t affect just healthcare providers. One study found that judges in court were more likely to grant lighter sentences or pardons earlier in the day. So if you find yourself being arraigned, try for a morning slot before he judge just burns out and gives up.
Or the airline pilot. By FAA mandate, all conversations not directly related to the flying of the aircraft are prohibited when the craft is flying below 10,000 feet. Interruptions of the flight crew during these crucial times in flight have resulted in catastrophes.
If you are interrupted no matter what you are doing, you can make mistakes. You just don’t want those mistakes while you are onboard an airplane.
Same with your doctor. They have to consider hundreds of data points in examining a patient. Each consumes brain power, bandwidth. Try to schedule your appointments earlier in the day.
Multitasking has been endemic in medicine, but it simply does not work and flies in the face of neurobiology. We cannot do two things at once. Studies show that when we attempt to do two things at once, it takes 50% longer to complete the task, there are 50% more errors, and there is a 40% decrease in retention rate. It is almost impossible for that provider to have a blistering focus on you, the patient in front of them, and not be distracted by thoughts and concerns of other patients and other personal issues.
How Can You Talk So Your Doctor Will Listen?
Okay, this is not brain surgery unless you are seeing a neurosurgeon, so what do we as consumers have to do to live in this reality?
1. Be crystal clear going into your exam about the reasons for the visit. Hit the big two issues or concerns right up front. This is not the time to drift into details about your daughter’s wedding, the new job, or how cute is the new grandbaby. Even email the doctor a day ahead with your list. And bring your list. Start your conversation there. This is your time.
2. Recognize that the physician who is reviewing your records on the screen cannot be attentive to the medical record and listen to you talking. Allow the doctor to review the record before you speak.
3. Within reason, bring someone with you to the medical encounter who can act as your surrogate, translator in interpreting the physician’s message. To take notes. Not talk.
4. Know your medications: dose, schedule, why are you taking the medicine and who prescribed it. Put this on the list.
Bottom line, key takeaway: No one has a greater stake in your health and well-being than you. Spend your time with your provider productively. And don’t let that doctor or that healthcare provider leave the room until your questions are answered. If you need more attention, get on the patient portal and email the doctor. Make another appointment.
Why isn’t your doctor listening to you? Now you know. And now you know what to do.
I explain more tips and techniques for making the most of your exam room visits and even telemedicine encounters in my book How Not to Be My Patient.
Image from Shutterstock.