Joseph Scherger, MD, MPH
Ever notice a patient wince when interrupted describing his or her problem? It is well known that physicians interrupt their patients much of the time and usually within 30 seconds of the start of the visit. One study in Family Medicine showed that residents interrupted patients 12 seconds into a visit 25% of the time (article pdf). We even teach interruptions as part of “controlling the conversation” and “limiting the agenda” for the visit.
In a practice where there is ample time for visits, there is rarely if ever a need to interrupt a patient. I’m now in such a setting after more than 30 years of brief office visits, and I had to train myself to not interrupt patients. What a great feeling that is! At our practice, we sit back and let every patient finish what he or she has to say. Patients notice this, too, saying they have never had a physician listen to them like we do. We learn things about patients they have not had the chance to share with physicians before.
Since we have an hour for every new patient visit, early in the encounter I ask the patient to tell me his or her story. The patient often asks, “Which story?” I say, “Where were you born and what happened after that?” It is amazing to me how most patients finish this story in about 5 minutes. As a matter of fact, I’m impressed with how brief most patients are when giving their narratives uninterrupted.
Our physicians are now demonstrating an uninterrupted communication style to medical students in their family medicine clerkships. By the time they arrive at our practice, they have already been taught to interrupt patients, so we teach them otherwise. Often, this helps them love family medicine. We look forward to training residents in uninterrupted narrative next year when our residency program starts.
Interrupting patients is a part of the paternalistic culture of medicine where the physician’s time is more important than the patient’s, and the physician knows better than the patient what the problem is. Such paternalism is unprofessional and even dangerous and should not be a part of patient-centered care.
I admire professionals who let people have their say completely. Counselors are very good at this and so are good lawyers, realtors, designers, and many others. Interruptions seem to be mainly a physician behavior.
Visits with patient can be efficient without interruptions. When patients have been given the chance to say everything they want during the visit, they are more receptive to hearing our assessment and recommendations for managing their problems. After all, patients are in charge of their care. Our job is to serve them, respectfully and without interruption.
