Heidi James MD and Vanessa Cardy MD
Take Home Points
- Doctors interrupt their patients at a median time of 11 seconds after the start of an appointment
- Sometimes it is important to provide a more rigid structure for some patients but the more we interrupt or lead the conversation the more pearls we can miss
- Vanessa and Heidi discussed the case of a diabetic patient whom Vanessa used to follow in her practice
- This patient was incredibly conscientious about his lab tests and appointments but despite this his HbA1C remained markedly elevated
- Vanessa repeatedly questioned him about his diet but would frequently interrupt him after he always answered that he always had two pieces of toast for breakfast, and she would then move on to discussing his other meals
- Many months later Vanessa decided to try a new approach for this patient
- She booked him for a long appointment time and started from scratch- reasking his past medical history, his family history, going over each medication on his list and addressing his lifestyle
- In doing so she asked once more about what the patient ate for breakfast. He once again answered “two pieces of toast” but this time he also said “with butter”. And then, when she didn’t interrupt, he went on to describe how every single morning for years he had eaten “toast and then three eggs and three pieces of bacon and two pieces of french toast, with maple syrup and baked beans on the side”
- Suddenly the elevated HbA1C made a lot more sense!
- Heidi and Vanessa discussed a recent study which showed that doctors interrupt patients an average of 11 seconds after the start of a patient-physician interview
- Discussion regarding the perils of not letting our patients talk and how interruptions, in addition to distractions such as the EMR screen or our smartphones, can seriously hinder patient care.
Journal of General Internal Medicine
January 2019, Volume 34, Issue 1, pp 36–40|
Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters, Naykky et al.