Is fifteen Minutes Enough---discovered at Doximity.com

[surgblumm]

Is 15 Minutes Enough?

By Saba Fatima, MDApril 11, 2018 Original article 

Featured in Op-(m)ed, a collection of original articles contributed by Doximity members.

Image: ESB Basic/shutterstock.com

One of the many lessons we are taught as physicians is to make a good clinical assessment and not to ask leading questions. If you direct the conversation, the thinking goes, you might miss important points in the history. In the real word, though, we all dread asking open ended questions that might open up the truth. We worry, in all honesty, that the patient might go on tangents if we start with something like “What brought you here today?” Why are we worried, though? Is it because we are not compassionate enough to listen to our patients? Or, is it that we feel so pressed for time that we have one eye on the door during patient visits? I guarantee the latter holds true for many of us.

When I was starting off as a resident, my biggest dissatisfaction with my patient visits was the lack of time I got to spend with them. I always felt like I had not given the patient the care that they deserved, and that they would walk out of the room dissatisfied. I had to obviously rush the visit because I had many other patients waiting to be seen. On one end of our spectrum, the world of healthcare today demands efficiency. On the other end, studies have shown that physician satisfaction is related to the perception of the amount of the time we spend with our patients and the relationships we have with them. From the patient’s perspective, time spent with the physician has a large effect on their satisfaction. How do you find a good balance, then, between the patients you want to treat and the endless piles of work that you have to finish each day?

I recently had the opportunity to analyze this from the patient’s perspective. I had to see two doctors for personal reasons, and I ended up being extremely satisfied with one and dissatisfied with the other. Leaving the medical aspects of each visit aside, I wonder, was time really the only determinant of my own satisfaction?

As I replay the first visit in my head, I remember the doctor had walked in, sat down on a chair — now on the same eye level as me — and started off with an open-ended question. He then did a very brief history and physical exam. He later spent a few minutes asking me about my profession. I felt a little gloating in my heart to tell him that I was a medical professional too. I guess I just wanted him to know more about me than just the body system that my presenting complaint was related to. When he was done, he gave me multiple cues to ask questions, and he looked patient, like he was not in a hurry to rush me out. He had turned multiple times to his computer to document notes, and I hadn’t seemed to mind that at all. Total time spent on the visit, 15 minutes. Did I want him to stay more? Hell no; I had to get back to work too and did not have all day for the doctor’s office.

The second visit was slightly different. The physician had walked in and asked an open-ended question, but he kept standing most of the time. Call me paranoid, but just the simple gesture of standing gave me a sense that perhaps he had to go somewhere else. There was no non-medical question asked. When I asked a question, I could sense a rushed tone to his voice, giving me a hint to maybe not ask more. Did he spend less time with me? He hadn’t. I kept track, and it was exactly 15 minutes. Was he less competent? I think not. Why did I end up walking out with the sense that maybe I should go to a different doctor next time? The answer to me was obvious.

These two visits have given me some great reflection on what may be important to patients when they go see a doctor. To my relief, time is not the only factor in this equation. It may be just one of many. Now, when I do a mental checklist of my own patient visits, I ask myself these questions:

· How often did I ask a patient or patient’s parent (I’m a pediatrician) a non-medical question?

· How often did I treat them as a separate individual, not just a patient or a parent?

· How often did I take the time to sit down?

· How often did I give them the lead to ask questions?

· Was I so focused on the disease that I forgot to look at the person?

In the past, when I didn’t do these things, I gave myself the benefit of the doubt and assumed it was because I didn’t have the time. There is no denying that as physicians, we do feel the pressure of time, but we sometimes forget that our patients may have been looking forward to their visit for a long time. Maybe we can make their visit more meaningful for them just by being more creative and present. After being on the other side, I can now see this with a different perspective. Can you?

Saba Fatima, MD, originally hails from Karachi, Pakistan and is currently training as a pediatrics resident in Philly. She has a passion for children and writing, and she hopes for a world where no child has to die because they cant afford to live. She is a 2018 Doximity Scholar. She tweets @SabaFatimaAli and blogs at https://sabafatimaali.wordpress.com/.

Original article 

[lkth487]

For some, 15 mins is too much. For others, not nearly enough. But it's the stupid way that reimbursement is given in our system.  It encourages me to be a bad physician - the more tests and interventions and procedures I do, the more revenue I generate.  

[surgblumm]

I agree with you as we need more information which is usually incorporated with additional testing and perhaps biopsies and other interventiond. No argument here

[sas5814]

It is an interesting article in that it incorporates one of the "tricks" I used to teach my students....put your butt in a seat. I do it every visit or I lean my backside against the counter and put my hands in my pockets as if I have all the time in the world. In reality I'm not giving them any more time...just giving the patient the impression. In what has now become a patient satisfaction business you have to sell the sizzle sometimes instead of the steak.

That said I do find my day much more satisfying when I have lots of time. Right now we are starting our slow period in the UC and I have the luxury of visiting a bit with the patient which really makes both of us happier. The bean counters? Not so much....

[beattie228]

28 minutes ago, sas5814 said:

It is an interesting article in that it incorporates one of the "tricks" I used to teach my students....put your butt in a seat. I do it every visit or I lean my backside against the counter and put my hands in my pockets as if I have all the time in the world. In reality I'm not giving them any more time...just giving the patient the impression. In what has now become a patient satisfaction business you have to sell the sizzle sometimes instead of the steak.

That said I do find my day much more satisfying when I have lots of time. Right now we are starting our slow period in the UC and I have the luxury of visiting a bit with the patient which really makes both of us happier. The bean counters? Not so much....

One of the best pieces of advice I got from a mentor was in relation to the above. 5 minutes of standing and hovering over the patient compared to 5 minutes of seated with legs crossed gives two very different impressions. When I go back into a room for final discharge, I'll sit again even though I've already wrapped it up during my previous encounters. It can be all of a 30 second conversation, but me seated gives the impression to the patient I have nowhere else to be but in that seat talking to them.

 

Multiple surveys of my encounters mention the same theme of "PA Beattie228 spent so much time with me" despite the fact that I spend the same amount of time (or sometimes less) than my counterparts. Just like a 5 star restaurant, the interaction is all about the presentation.

[GetMeOuttaThisMess]

I rarely sit.  There is no place for sitting with serious cases of snot and cough.  Each case is life threatening (so says the pt.).  

[surgblumm]

I enjoyed Beattie and SAS comments as it is fundamentally correct. At the conclusion of your shift you can always use some dial soap in the shower and prepare for the next day.

[thinkertdm]

In the VA we have these things called alerts, civilian practices have similar things for when something needs your attention.  The problem- it's never the patient.  Ding- needs orthotics.  Ding- orthotics ordered.  Ding- orthotics released.

The number one thing I've heard over my first two weeks is that no one's listened.  Because we've been trained to address the alerts, the treat releasing lever.  A monkey can be trained to do most of those.  Turn away from the computer.  Look at the patient- the person- in the eye.

I hear " I'm too busy!" I got to work that lever for the treats!  We made this system.  It ain't gonna change until we stop it.

I went with my wife to a provider.  My wife could have been on fire, but the provider would never have known, because the computer took up her attention.

[Guest ERCat]

I sit. When taking the history almost every time. I sit on the provider stool or even sometimes on the bed alongside the patient. It makes a huge difference. If I’ve somehow blown through the whole encounter standing, I make sure I am sitting when I discharge the patient. The moment I sit down I can feel the patient’s anxiety decreasing and the walls coming down. 

[surgblumm]

Excellent approach ERCat and the patients love it.