Give me Two Minutes... Just Two Minutes

[Kristy]

Two minutes is all most patients need to tell their story

September 27, 2002

 

LONDON (Reuters Health) - Physicians who let their patients tell the full story of their complaints do not risk listening for hours, Swiss researchers report in the September 28th issue of the British Medical Journal. In fact, they found that the majority of patients finished their litany within 2 minutes.

 

US physicians give patients an average of 22 seconds before they take the lead in the conversation, probably because they are afraid patients will "mess up" their schedule if allowed to go on, note Dr. Wolf Langewitz and colleagues from University Hospital in Basle. But this fear has not been systematically put to the test.

 

The researchers equipped physicians in the outpatient clinic of a department of internal medicine with a stopwatch, which they surreptitiously started at the beginning of the conversation and stopped when the patient said, "What do you think, doctor?" or otherwise indicated they wanted the doctor to take the lead.

 

Of 335 patients seen by 14 doctors, the mean talking time was 92 seconds, and 78% of patients had finished talking within 2 minutes. Only seven patients talked for more than 5 minutes.

 

"Even in a busy practice driven by time constraints and financial pressure, 2 minutes of listening should be possible," the researchers write.

 

"We gathered data in a tertiary referral centre that is characterised by a selection of difficult patients with complex histories," they point out. "Patients in less selected groups might need even less time to complete their initial statement."

 

BMJ 2002;325:682-683.

[Guest Simone]

The Dr is the one place you know your really going to be rushed at,it's also the one place in life you really shouldn't be rushed at.If I had just had one thorough discussion(that implies feedback)I would have had a diagnosis yrs ago and already been better.What a mess it makes in the long run to rush a patient.

 

:but:

[Guest Julye]

Very intersting Kristy...

and it is probably true.

If i look back, 2 minutes its probably what it take for most people to summarize their story.

I know i usually practiced aloud my own story before seeing the docs to make it short and complete. (never time myself....)

But when i worked, guilty as charge, i probably took over most discussions after 1 minute...especially when patient come for specific opinion and that i already received a letter of information from their own doctor...

this is not what i learned in med school, "you should listen to the patient"...

but when patients are boocked every 15 minutes, including time to go in/out the office, sit down and change gown... pager and phone bipping at least once an hour during clinic, teaching to resident on the side, the waiting room is full, some patients are angry of waiting (and some tell you in a very direct way) and administrative meeting to discuss budget at 5pm....it feel like you have to rush...

 

not an excuse, should not be that way, but a reality.

 

I'll check the article, might be something to give to my students

I'll remember this...

[~SuziQ~]

Sometimes I must be very fortunate. ?My endocrinologist spent over an hour with me on my first visit and about half an hour on my second visit. ?Those were my only visits with him before surgery.

 

Now, my family doctor is a different story. ?Zip in and zip out. ?Normally. ?On the day I saw him one week before my surgery, he spent a lot of time working for me. ?When I left his office almost an hour and a half later, I vowed to never get upset again if I had to wait for the doctor. ?You see, I didn't have surgery scheduled when I got there, but I was so critical that he spent all that time finding me a doctor and finding me a doctor NOW. ?I was fortunate that I did not need a neurosurgeon. ?I needed a surgeon that could remove an adrenal tumor. ?Luckily he found me one who felt confident he could do my surgery. ?The next day when I met him (between surgeries) and talked with him, I was confident he could do it. ?And he did. ?Six days later.

 

It is true that you don't spend much time with your doctor.  I sometimes wonder how they can diagnose us with anything as quickly as they scoot us out the door.  I feel like quality is given up for quantity most of the time.

[Guest Tracey(Kiwi)]

     

 

Boy!Once again I thank the Lord for how lucky I really am! :B:

 

Every time I see my general practitioner,I know that she will give me all the time I need,no matter what the subject.I also address her by her first name,at her request.I know her staff by there first names,and they all know mine.This is with all her patients,and it is not a small medical surgery either.There are 5 Dr.s associated with this medical centreand it is always busy.The Dr.s and specialists at Dunedin Hospital I know by their first names also,by their request.They also spend as much time as is needed by the patient and don't feel like they have to "rush" to get done by a certain time limit.They actually treat you like you're worth talking to! It does'nt matter whether you need 5 minutes or 30,you get what you need.

 

Tracey.

[Valerie]

Tracey,

First of all HAPPY BIRTHDAY! You are very lucky to have a doctor spend so much time with you.  Very rare.  I've been going to UCSF for 2-1/2 years and now am going to see the head endo their in his private practice without the fellow residents.  My great resident left to become a real doctor and I've been tossed around and am sick of it.  So now we'll see how much time the big guy gives me.  I don't need doctor's in training asking all the questions and having to repeat myself to the big guy, what a waste of time. I do go in prepared with my list of questions everytime I go in there and I do insist he answer all my questions before I leave.  Good research Kristy and thanks for letting us know how poor our healthcare is in the country.  Just re-inforced it for me, something you know but don't want to admit or accept.

[Kristy]

When I saw this article, I thought it was important to post it... seems that it hit a little nerve too.

 

Let's see here. When I was first going through testing, I saw my pcp (been seeing him for 4 years). I had a sinus infection. While I was there, I told him that I saw an endocrinologist and that a pituitary tumor was found. He asked me if the tumor was hormone secreting. I told him that I did not have my labs with me, but I remember that there were some elevated hormones. He was in a hurry. I told him that testosterone was mildly elevated, that TSH was mildly elevated, and prolactin was mildly elevated... and

 

He interupted me and told me that I could be on drug therapy for my prolactin and everything would be just fine. He handed me a script for antibiotics.

 

I tried to tell him there was one more...

He was out the door before I could say cortisol.

 

Oh, that wasn't the first time that had happened, so I changed my pcp.

 

Your experience, Valerie, is one of the pitfalls of having a case managed at a teaching facility. The patient is the "teacher".  My personal charge out rate is...  

[GoodIdeaLady]

My supposed pre-op visit at the University of Washington Medical Center [a teaching hospital] was 5 1/2 hours of  curious drs and students streaming in and out.   The Oregon Heath Sciences University was only 2 1/2 and that included my waiting for blood work to be done and to fill a prescription.  I have been called by an endo and asked to come in on an early date for my appt ---- because he had an internist who wanted to meet and interview the Cushiod.  Yes, we should be allowed to charge, but we also are eager to inform, so others won't suffer the delayed and / or misdiagnosis that most of us had to endure.  If only they had given us those 2 minutes, and with an open mind, eh?