The 15-minute Doctor Visit

The 15-minute Doctor Visit

April 27, 2016 by Dr Ali Nurani1
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Think back to the last time you were at your doctor’s office. Did you feel rushed during your visit? How many complaints were you allowed to talk about? How many minutes did the doctor spend with you? Was your doctor even listening? Did he end up prescribing a pill or referring you to somebody else? Did you feel empowered or motivated after the visit?

Unfortunately this is what the delivery of primary healthcare has come to. Our healthcare system is becoming stressed, our doctors are overburdened and the quality of our healthcare is suffering because of it.

Some interesting facts…

  • Doctors interrupt their patients on average within 23 seconds from the time the patient begins explaining their symptoms. In 25 percent of visits, the doctor doesn’t ask the patient what is bothering them (1)
  • Shortened office visits are contributing to diagnostic errors by primary care physicians (2)
  • Patients are initiating fewer topics, asking fewer questions and answering curtly — as a result, doctors may be underestimating the severity of their diseases or injuries (3)
  • 30 percent of the time, doctors forget important information their patients tell them (4)
  • Doctors are exhibiting avoidance behaviours regarding discussion of the emotional and social impact of patients’ problems due to potential distress to the doctor or not enough time (5)
  • Physicians that don’t communicate belief in, or understanding of their patients, are actually causing patient symptoms to worsen (6)
  • Patients are receiving only 55 percent of recommended care for 30 different medical conditions studied (7)

Canada now maintains a “B” grade and 10th-place ranking among the 17 peer countries in health outcomes


There are number of interventions at various levels that are needed in order to reform our healthcare system, but as a healthcare practitioner, I believe it is important to start with the basic doctor-patient encounter. In particular, the short unengaged in-office visit is an area of concern that is creating some problems and needs to be addressed:

1. Patient Judgment

Limiting the patient to report only one or two concerns per visit may present health risks.

How does the patient figure out which of their many symptoms is the most crucial to their health? Patients may not have the knowledge, skill or judgment to do so.

In addition, the issue most important to the patient may not be the most clinically significant issue. Consistent bloating, which can be related to colon cancer may be overlooked by the patient who is more concerned with sleeplessness.


2. Small Problems of an overall Bigger Problem


Sometimes it is dangerous or even negligent to impose limits on time or number of complaints during a visit:

  • A patient that complains of back pain and abdominal pain may have an inflammatory bowel disease
  • A patient with a migraine and overwhelming grief may need both concerns to be addressed in the same visit
  • A patient with weight gain and depression most likely has underlying deep-seated issues of self worth and self esteem that need to be addressed concurrently

In cases like these, a doctor has to be diligent to address all related concerns in the same visit as they offer key insights into the patients underlying health concerns.

3. Quality of Care

Patients who don’t feel cared for are less likely to be engaged during the visit and patients who ask questions are more engaged when they leave the office.

Also, in short unengaged visits, there is a higher likelihood that the doctor will impose his own mandate and judgment rather than being client focused by discussing and defining the goals of the client.

A patient’s contact with his physician is often a first step toward reconnection especially if the patient does not have a supportive social network. The doctor-patient relationship becomes even more critical to overcome the struggle when describing their illness and symptoms for the first time.


4. Treatment Effectiveness & Compliance


If the patient feels that the doctor hasn’t taken the time to listen to their concerns, how will that patient trust that they are receiving the right drug or the right test?

It is difficult for the patient to foster self-awareness or engage in meaningful change in behaviour, thoughts or beliefs when the doctor does not fully invest in the patient.

Also, shorter visits increase the likelihood that the patient will leave with a prescription for medication, rather than for behavioural change — like trying to lose a few pounds, or going to the gym.

Why not take the time to understand the patient’s concerns and recommend interventions that will actually make a difference in their health?

THE THERAPEUTIC RELATIONSHIP


Patients are people and people need to be heard and understood and made to feel important. Visits with your doctor should involve questions, ideas, goals, reassurances, encouragements, jokes, etc. Information should flow freely from patient to doctor and vice versa.

The therapeutic relationship is one of mutual trust and respect where your doctors fosters faith and hope in your wellbeing, invests time and knowledge in your health, shows genuine concern, empathy and interest while being sensitive to your physical, emotional, and spiritual needs.

Many doctors today don’t have a therapeutic relationship with their patients. With one eye on their patients and the other on the clock there simply isn’t time or opportunity to do so. As doctors, we are missing a great opportunity to make an impact on the health of our patients and this is a tremendous disservice.

See a Naturopathic Doctor…

The basic foundations of the therapeutic relationship are pre-built into the delivery of naturopathic medicine:

  • Naturopathic doctors believe in the Holistic Principle which means that all parts of the body are interconnected as well as there is a connection between your physical body and your emotions, mind and spirit as well as your environment.
  • The very processes used to determine the underlying causes of illness requires the doctor to be dialed-in, engaged, empathetic, attentive and listening actively.
  • Naturopathic doctors typically spend a long time during the visit getting to know and understand their patients and are well equipped to recognize and address multiple concerns and emergent issues.
  • Some visits last more than an hour and the doctor spends several hours thereafter trying to come up with an individualized treatment plan for the patient.

In this type of healthcare delivery, the doctor and patient form a strong partnership. The patient is usually fully engaged in their own treatment, motivated and empowered to make the necessary changes and typically will have a higher rate of compliance and success with their treatment.

REFERENCES

  1. Marvel, M. K., Epstein, R. M., Flowers, K., & Beckman, H. B. (1999). Soliciting the Patient’s Agenda. Jama, 281(3), 283. doi:10.1001/jama.281.3.283
  2. Newman-Toker, D. E., & Makary, M. A. (2013). Measuring Diagnostic Errors in Primary Care. JAMA Intern Med, 173(6), 425-426. doi:10.1001/jamainternmed.2013.225
  3. Tai-Seale, M., Mcguire, T. G., & Zhang, W. (2007). Time Allocation in Primary Care Office Visits. Health Services Research, 42(5), 1871-1894. doi:10.1111/j.1475-6773.2006.00689.x
  4. Doctors and Patients Overwhelmingly Agree on Health IT Priorities to Improve Patient Care. (2011, January 19). Retrieved April 26, 2016, from http://www.markle.org/about-markle/media-release/doctors-and-patients-overwhelmingly-agree-health-it-priorities-improve
  5. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ : British Medical Journal. 2002;325(7366):697-700.
  6. Greville-Harris, M., & Dieppe, P. (2015). Bad Is More Powerful than Good: The Nocebo Response in Medical Consultations. The American Journal of Medicine, 128(2), 126-129. doi:10.1016/j.amjmed.2014.08.031
  7. Mcglynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., Decristofaro, A., & Kerr, E. A. (2003). The Quality of Health Care Delivered to Adults in the United States. New England Journal of Medicine N Engl J Med, 348(26), 2635-2645. doi:10.1056/nejmsa022615

Dr Ali Nurani


One comment

  • Megan

    April 27, 2016 at 3:14 PM

    Great post! I couldn’t agree more with these points.

    Reply

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