How patients and doctors can improve the primary care office visit

Consumer Reports recently released a survey of both patients and primary care doctors, regarding their perceptions of each other.

Some interesting findings, as summarized by the WSJ’s Health Blog:

On the issue of respect and appreciation, 70% of doctors said they were getting less of it from patients than when they started practicing. For patients, meantime, the more they reported being treated respectfully and listened to, the more satisfied they were with their physician.

Respect matters. Treating health professionals in a courteous manner definitely helps when receiving medical care. On the flip side, physicians also need to respect patents, as it positively impacts patient satisfaction.  Both parties need to improve in this area.

Doctors said insurance paperwork topped their list of things that interfere with their ability to provide the best possible care. Financial pressure was No. 2.

No surprise here. Primary care doctors are continually inundated with increasing amounts of bureaucratic paperwork. This includes pre-authorization of medications, pre-certification of imaging studies, along with endless forms that both Medicare and insurance companies require. This obstructs patient care, and leads to physician burnout. Burnt out doctors not only leave the field earlier, it worsens the care they give to their patients.

Some 80% of physicians said it would be helpful for patients to bring a family member or friend to a visit in order to make sure important information is recorded and retained; only 28% of patients said they did so. And while 89% of doctors said it would help patients to keep an informal record of treatments, tests, procedures, drugs and changes in conditions, 33% of patients reported routinely doing so.

Good advice here on how patients can maximize their primary care visit. In most cases, doctors are allotted 15 to 20 minutes per visit. And when you consider that some patients have complex medical issues, that isn’t a lot of time. Taking notes during a visit, bringing a list of your medications and having questions already written out in advance can facilitate a patient’s physician encounter.

Patients are big online research fans, with 61% saying they had turned to the internet for information on their medical care. Doctors are not big fans of this kind of research, with nearly half saying it helps very little or not at all, and 8% saying it was very helpful.

Here’s where I think doctors need to change their attitude. No matter what doctors think about online health research, it’s going to happen anyways. As I wrote in AOL News,

With only 7 percent of doctors e-mailing their patients, let alone engaging them on blogs, Twitter or Facebook, the medical establishment needs to realize the influence of the Internet and social media on patients.

Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites.

Resisting that trend will only worsen the disconnect doctors have with patients, and make it more difficult to treat them face to face in the exam room.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Davis Liu, MD

    Agree and all excellent points. Would also add that primary care doctors matter and having a long-term relationship with one can save time and money.

    http://davisliumd.blogspot.com/2011/02/what-doctors-wish-their-patients-knew.html

  • Lola

    The problem is that there’s almost no upfront information about the personality and style of a doctor..

    • http://www.BocaConciergeDoc.com Steven Reznick MD

      At the same time there is no upfront information on the patient either. It works both ways.

  • http://www.wix.com/psychologysolutions/psych David Pollak, Senior Psychologist

    This is a very interesting article.

    I am Senior Psychologist at Australian Psychology Solutions.

    I have found that the three equally essential ingredients in an effective Psychological intervention are:
    1. Rapport;
    2. Ethics; and,
    3. Competence.
    They are all equally essential.

    If any one of these are missing, then sure, effective and successful interventions are clearly still possible, but by applying all of these there can be a noticeable increase in the effectiveness of most Psychologist interventions.

    I still recall being an intern and hearing colleagues talking to each other about how important rapport is whenever working with clients. Those were wise words that I still apply today, and my colleagues were great role models when I was starting out all those years ago.

    And that’s a big part of what Kevin’s saying in his blog article – how important rapport is.

  • http://secondbasedispatch.com Jackie Fox

    I loved this. Having questions prepared as a patient and not doing that last second “Oh by the way” are good things (although sometimes it takes us awhile to work up our nerve to bring something up). But the key, which you nailed, is mutual respect. My doctors have earned mine for life and I hope I have earned theirs.

  • Amy Wencel

    Patients are well served to establish with a patient advocate, and PCPs should encourage this with their patients who need more time with education and decision-making. The advocate will be both well versed in the history, diagnosis, and treatment plan of the patient, and medically literate enough to explain, or research EBM and present to the patient what the provider is offering. Please get the word out that patient advocates are a burgeoning resource that can grease the skids toward delivering quality care.

  • Finn

    I started taking notes, logging symptoms, keeping medication lists, and writing questions in advance when I was diagnosed with cancer. I’ve maintained the habit because it’s very useful, especially for chronic conditions and for intermittent signs (like supraventricular tachycardia) and symptoms (like palpitations) that don’t perform on cue during office visits.

  • Jackie

    The hospital/clinic I use seems to have adopted a system for patients to fill out detailed forms while waiting for their appointment. But I’m not sure if all my doctors read them before they enter the room.

    I know at least one of them did. He’s the head of the gynecological oncology department. The first words he said to me was: “You’ve been through a lot.” That statement totally changed my attitude. Instead of having to describe my lenthy medical history like a ‘victim’ who begs for attention, I felt like I was dealing with someone who’d already know about my medical problems and we could focus on the ‘present’ issue.

    It is a also good way for the patient to clear their mind and get organized before talking to their doctor.

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