Blog post by Joe Babaian
Seek First to Understand, Then to be Understood – Steven Covey
Is your doctor really present during your visit? – Suzanne Koven M.D.
We’ve all been there. At the bank, the grocery store, the mall, the clinic, and the hospital: We spend a few minutes explaining what we want and we get the blank-looked reply and a response ranging from “huh?” to some words that don’t begin to address the request. It’s understood that everyone is pressed for time and every organization faces financial pressure, yet we haven’t found a way to assure clear understanding from the most important communications – those in healthcare.
A few days ago, Sherry Reynolds tweeted:
Is there really a doctor shortage (supply side) or a delivery side one? IE Most ER visits are due to lack of access to primary care
— Sherry Reynolds (@Cascadia) September 11, 2015
Dave Chase replied to Sherry with a telling comment:
@Cascadia Delivery side. Any so called doc shortage is a failure of imagination (part of which is a flawed reimbursement structure)
— Dave Chase (@chasedave) September 11, 2015
A complex and important question to be sure. The very pressures of the real, imagined, or created doctor shortage finds its roots in financial pressure and the “shortage” manifests itself in difficulty getting an appointment and when you do get one, you often face the communication gap.
No one expects 45 minutes to chit-chit with your PCP about the weather, but if you do have 15 or 20 minutes, you should expect authentic conversation. In fact, the disservice of one-way communication is to both the clinician and the patient. The patient needs/issues/changes are often not understood, leaving the patient at risk. Further, the clinician finds themselves at risk of not providing care but just being there but not present.
Suzanne Koven M.D. talks about this in her telling article, “Is your doctor really present during your visit?” when she notes:
Am I “present” in my practice, even when I am in?
She considers the 1984 study that found physicians interrupting patients within 18 seconds on average and sees little improvement over 20 years later in “Tell the Doctor All Your Problems, but Keep It to Less Than a Minute” when it comes to understanding via authentic communication:
50 percent [patients] leave their doctors’ offices uncertain of what they are supposed to do to take care of themselves.
Increasingly, more and more physician time gets taken up with the iPatient, leaving the real patient in the bed feeling neglected. And the bizarre way health care is funded and the way incentives are lined up in this country (we are paid to do to people, rather than for people — sticking a needle in or performing a test pays more than listening), we are pushed to spend more time with the “iPatient” (much of it spent documenting the time we supposedly have spent with the live patient).
Certainly we all recognize this paradigm and face the looming obstacle of shifting to a new track, getting something done, and reengaging authentic communication that allows care to truly begin with each patient interaction. After all, aren’t the people the reason healthcare exists?
Let’s consider where we’ve been, where we are, where we need to be as well as the implications along with the #hcldr community of professionals, patients, clinicians, administrators, lurkers, counselors, social workers, designers, and advocates! Please join us on Tuesday September 15, 2015 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:
- T1 How critical is the need for authentic listening in healthcare and why? Is this related to the “doctor shortage?”
- T2 Do you agree with Dr. Verghese’s characterization of the healthcare treating “iPatients” vs. “real” patients?
- T3 What experiences do you have with poor (or no) communication in healthcare? Did you find a way to overcome?
- T4 What can we do to #shift the model and create the real connections that enable care once more?
“Doctors, listen to your patients” Abraham Verghese, CNN, Oct 02, 2011. http://www.cnn.com/2011/10/02/opinion/verghese-doctors-touch, accessed Sep 12, 2015
“The Effect of Physician Behavior on the Collection of Data” HOWARD B. BECKMAN, M.D. and RICHARD M. FRANKEL, Ph.D., Annals of Internal Medicine , Nov 1, 1984. http://annals.org/article.aspx?articleid=699136, accessed Sept 10, 2015
“Is your doctor really present during your visit?” Suzanne Koven M.D., KevinMD, Aug 5, 2013. http://www.kevinmd.com/blog/2013/08/doctor-present-visit.html, accessed Sept 11, 2015
“Lack of Listening is the Core Problem in American Health Care” Stephen C Schimpff, MD, Medical Megatrends and the Future of Medicine, April 14, 2014. http://medicalmegatrends.blogspot.com/2014/04/lack-of-listening-is-core-problem-in.html, accessed Sept 12, 2015
“Tell the Doctor All Your Problems, but Keep It to Less Than a Minute” Meredith Levine, New York Times, June 1, 2004. http://www.nytimes.com/2004/06/01/health/tell-the-doctor-all-your-problems-but-keep-it-to-less-than-a-minute.html?pagewanted=all&src=pm, accessed Sept 11, 2015
“A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings” Wendy Levinson, MD; Rita Gorawara-Bhat, PhD; Jennifer Lamb, BS, JAMA, Aug 23, 2000. http://jama.jamanetwork.com/article.aspx?articleid=193022, accessed Sept 12, 2015
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