Time to Talk

Often the most time-consuming part of a patient evaluation is eliciting the so-called "history of the present illness." 

The benefits of listening to the patient's whole story include:

• narrowing down the possible diagnoses most efficiently, thus making a more timely diagnosis and avoiding unnecessary tests.
• gaining the patient's trust.
• gaining insight into other medical problems.
• gaining insight into the patient's fears, anxieties, misconceptions, attitude, hopes, needs, stresses, responsibilities and support system.
• bringing the patient comfort, even when nothing can be done to improve the situation.

The problem is that talk takes time. And nobody seems to have enough time, anymore.

If we want tomorrow's clinicians to be compassionate -- if we want clinicians to care for people, and not just treat diseases -- we need to value the time it takes to talk. And to listen.

(from Only 10 Seconds to Care) "Since at least the time of Hippocrates, the practice of medicine has been an art based on science. Despite all the changes of our modern age pulling you [clinicians] farther and farther away from your patients, healing still begins the moment you use words or touch to make contact with your patients. And I believe that no matter how clinical practice changes in the future, the heart of medicine will always lie deep within the clinician-patient bond."

Comments

[ria]

wow-lovely, lovely post! Thx! + no doubt: for the course of the treatment trajectory, taking the time to really talk with the patient from the onset, 'gains' time later into the patient/doctor bond...

[kate]

I couldn't agree with you more. Well said!

[Wendy S. Harpham, MD]

Dear Ria,
Exactly. With hope, Wendy

[B]

Wendy, where can I purchase Only 10 Seconds to Care?

[Wendy S. Harpham, MD]

Dear B,

Good news: ONLY 10 SECONDS TO CARE just went into a second printing! I just checked, and Amazon has books in stock:
http://tinyurl.com/ylx6w35

Or you can visit my website, which has links so you can order directly from the publisher:

http://www.wendyharpham.com/Pages/ONLY10SEC.htm

Please email me if you have any trouble ordering a book.

Happy reading! I hope you find it useful. With hope, Wendy

[Jackie]

Hi Wendy
I'm working on my paper and using your blog for inspiration :)
Lots and lots of love,
Jackie

[Roz]

So true! I'm taking my 93-year-old mother to three (routine) medical appts today, tomorrow and Monday. The doctor she likes the best is the one, a wonderful geriatrics MD at UCLA, who takes some time and truly listens to her. The one she likes the least is the one who, without explanation or apology, kept her in the waiting room for 2 1/2 hours on her latest visit and then spent about 2 minutes with her. I'm hoping today's appt with the same doctor goes better than that one.

[Felicity Lenes]

One technique we're being taught as first year med students is to elicit ALL of a patient's concerns for a visit (to avoid "and by the way, doctor, I have chest pain radiating down my left arm" as the patient is walking out of the door) and enlisting the patient's help in prioritizing concerns for a visit (if they have more concerns than can be well-addressed in one session.) We read a paper that said the average amount of time a doctor lets a patient tell his or her story is 32 seconds before interrupting and co-opting the remainder of the interview, and that this actually leads to inefficiencies in the visit, and sometimes even a wrong or incomplete diagnosis. The hard thing as we learn to interview patients, whether "real" or "standardized," is to be comfortable with silence. It feels kind of awkward, but invariably the patient will provide more information if we just let them. Dr. Harpham -- your posts are so timely! I feel like I'm getting real-time applications to show me why my courses are so important:-)

[Wendy S. Harpham, MD]

Dear Felicity,
I'm so glad to learn that you are finding this blog useful as a first year medical student.

Actually, some of the studies put the average amount of time before an interruption at - gasp - 18 seconds.

When I was in practice, I asked certain patients to make a list of all their concerns and to prioritize it, as you suggest. Sometimes it was clear that we could only address 2 or 3 of the problems on the list. Yet we benefitted from having the whole list, because I could skim it and pick up potential serious problems that the patient had put lower on the list than things that worried him/her but were likely less important from a medical point of view.

This is a good topic for my next blog post, so stay tuned.

Enjoy school! With hope, Wendy

[Kairol Rosenthal]

Here's how I as a young adult cancer patient have adapted to the time crunch:

Prior to my appointment I type a basic outline of my history, a list of my current symptoms, a list of all medications I am on, and a prioritized list of my questions. I hand this to the doc, he scans it and gleans a lot of information that it would have taken quite a while to get in conversation. This frees up time to allow us to dive into tangential questions, deeper investigation, the meat of the matter that can often lead to curiosity about different treatment paths or even different diagnoses.

I often understand why the time crunch exists for my docs given the shortage of doctors, financial pressures put upon doctors, and the fact that I often see top notch docs who have many patients knocking down their door for their expertise.

As a proactive patient, my best tool for health is helping my doctors do their job better regardless of their constraints.

Great post Wendy. Congrats on your book going into a second printing.

Best,

Kairol
blog http://everythingchangesbook.com