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« "Disease" or "Illness"? | Main | The Toughest Stage »

October 27, 2009

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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

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