Every doctor knows this story: Buried in administrative paperwork, an over-demanding schedule and not enough time to spend with patients.
While the doctor-patient relationship is the cornerstone of good health care, like any relationship, it can be tricky to it get right.
“In the past, patients were more passive, they relied on their doctor to tell them what was wrong with them and what they should do to treat their condition,” said Elliott Antman, M.D., president of the American Heart Association, and associate dean for Clinical/Translational Research at Harvard Medical School in Boston. “Over the years, patients have become more engaged in their care, but the administrative demands of being a doctor can limit the time available to attend to their needs in a comprehensive fashion.”
The newest generation of primary care physicians reportedly spend only an estimated 8 minutes per patient visit. According to a study recently published in the Journal of General Internal Medicine. Doctors spent 12 percent of their time in direct patient care and 64 percent in indirect patient care, such as managing patients’ medical records or researching patients’ histories. Computer use consumed 40 percent of their time.
The time invested matters, according to recent studies which have linked shorter visits with increased rates of medication prescriptions. Meanwhile, longer visits allow for discussion about preventive health and topics of interest to the patient. In fact, research indicates that patient satisfaction isn’t necessarily about how many minutes a doctor spends with a patient, but whether the patient felt listened to and involved in his or her care.
Dave Woods had doctors too busy to listen.
Then in 1984 he was seeking treatment for an arrhythmia and visited Antman. About 30 years later, Woods sought Antman out when testing confirmed the need for stents to open up heart blockages that posed serious risks. Woods’ also had a family history of cardiovascular disease.
While the years and treatments change, the importance of listening does not. The growing variety of treatments — including breakthrough medications, minimally-invasive surgical techniques and the use of sophisticated devices — has changed the doctor-patient dynamic.
“With other doctors I often felt like a cog in the wheel, but Dr. Antman listened to my story for over an hour,” Woods said. “This was not lost on me because I know how busy and important he is. The physical exam itself only took five minutes but what I was most impressed with was his willingness to listen.”
“More options means there’s more to talk about,” Dr. Antman said. “There’s no single way of treating a particular type of cardiovascular disease anymore, there are many ways, and knowing which way is best for the patient means having a more in-depth dialogue with your patient. Ultimately, we need to see more organized data on patient preferences and eventually see that information introduced into our clinical practice guidelines.”
Changing technology, such as email, also created a new way for doctors and patients to communicate.
“Email is a very simple way to make yourself accessible to your patients,” Antman said. “I keep an email address that’s separate from my personal email so that patients can send me questions.”
Woods said he has emailed Antman with questions and concerns. Just knowing someone is listening, makes a huge difference about how he feels about his care.
“You really need to find someone who is willing to listen because you can go home and wonder what to do or try to figure things out on your own and that can be very defeating and discouraging. You need a doctor who is willing to invest the time,” Woods said.