First published on WSJ.com
on April 9, 2013
In all of medicine, this is the simplest question to answer, but has the hardest solution to implement.
To get the biggest improvement in physician-patient communication, physicians need do only one thing: slow down.
In the U.S., the median duration of visits to office-based physicians is less than 15 minutes. That’s not very long to do all the black-and-white things that need doing. So it’s unsurprising that communication—being the pre-eminent shades-of-gray activity—is reduced to bare minimums.
Electronic health records have compounded this problem because they, too, demand communication time from the physician. And being legal documents, their need trumps the patient’s need. The next generation of EHRs will continue to have clunky interfaces and will therefore continue to steal time from the patient. Hopefully, the generation after that will actually improve the physician’s efficiency, and repay time previously stolen from patients.
Even after that happy day, however, time considerations will still dominate physician-patient communication. With the sole exception of military aviation, where flight surgeons integrate themselves into the flying activities of their patients and thereby enjoy unconstrained interaction, there will never be enough time.
Realistically, the best thing physicians can do to improve communication is put themselves into the heads of their patients. Done right, this results in using language that matches the faculties of the patient, minimizing distractions and interruptions, and anticipating questions.
One of my clinical heroes, Dr. Philip Tumulty of Johns Hopkins, wrote: “A pair of kidneys will never come to the physician for diagnosis and treatment. They will be contained within an anxious, fearful, wondering person, asking puzzled questions about an obscure future, weighed down by the responsibilities of a loved family, and with a job to be held, and with bills to be paid.”