Put patients to work during their wait time

I talk with lot of physicians about the need to improve the quality of communications between physicians and patients.   Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the physician and provider community.

Physicians with whom I talk seldom disagree as to the need for better physician-patient communications.   They know that physician communication skills top the list of patient complaints about their physicians, i.e., my doctor doesn’t listen,” “my doctor ignores me,” and so on.   Rather, they simply dismiss the subject out of hand as being impractical due to a “lack of time” on the part of most physicians.

I can understand their perspective.   Primary care physicians in particular are faced with sicker, more demanding patients, increased payer and regulatory requirements, and are constantly pressured to see more patients.

Yet physician waiting rooms and exam rooms are full of engaged patients (otherwise they wouldn’t be there) who have nothing to do but read outdated magazine.

What would happen if physicians actually put patients to work during wait time?

Here’s what I mean.

What if physicians integrated patient “wait time” into the office visit by:

  • Talking to patients (via printed handouts, electronic media, patient portals, etc.) about their evolving new role (and that of the physician and other providers) under health reform.  Contrary to the popular press which touts the empowered patient, most of us still assume the traditional “sick role” during the office visit.  The sick role is characterized by patient passivity, limited information sharing, and minimal question-asking.
  • Teaching people while waiting how (using the same media as above) to become “better patients.”   I recall an article where physicians were asked 5 things they wished their patients knew.  At the top of the physicians’ “wish list” was a desire for patient’s to be better prepared and more focused during the visit.  The point being that more prepared patients would help the physician get to the correct diagnosis and treatment plan faster.

All of us, beginning in childhood, are socialized into playing the sick role when interacting with physicians.   Just as chronic disease patients needing to develop self care skills and confidence in their self care skills, patients need to be taught skills for (and develop confidence in) how to more effectively talk to and collaborate with their physicians.

Laying out a game plan (over a series of visits) for teaching new and established patients when and how to effectively contribute to the medical interview (exam).   Given an average wait time of 22 minutes per primary care visit, it is not reasonable to assume that patients can be taught the above in the course of 1 or 2 visits.  But patients with chronic conditions often visit their PCP 6-8 times a year.  This would afford plenty of time (2-3 hours a year) for physicians to teach (and practice) individual skills to patients (i.e., agenda setting and prioritization, question asking skills, self-care management skills, new medication considerations, etc.).   By reinforcing lessons learned by patients over the course of several visits, it is reasonable to expect that both patient and physician will become more proficient in the use of their time together.

How exactly will better physician-patient communication lead to more productive visits?

Research has consistently shown that patient-centered communications (versus traditional physician-directed communications) can result in more productive office visits as measured by 1)  the amount/quality of information shared by patients, 2) the number of questions asked by patients, and 3)  and the level of patient retention of information shared by physicians.

These same studies show that the adoption of patient-centered communications adds little if any more time to the length of office visits.  Once patients and physicians become proficient in the use of patient-centered communications methods,  physicians may well be able to do more during the visit but in less time.  Here are some of the techniques characteristic of patient-centered  communications associated with increased visit productivity:

  •  Concise visit agenda setting and prioritization wherein both physician and patient  agreed to what can be discussed within the time allowed.  This  also eliminates the “oh by the way” introduction of last-minute patient agenda items that can occur at the end of the visit.
  • More concise  sharing of relevant information by the patient
  • Greater physician-patient agreement as to the diagnosis and treatment
  • More collaborative decision-making
  • More information retention by patients
  • Greater patient adherence

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • karen3

    1) It would make me even grumpier to be forced to listen to prepackaged lectures while waiting. Not a good idea.
    2) Most doctors HATE patients who have prepared for the appointment, have lists, etc. Why, because the control of the meeting then rests with the patient and his/her agenda, not the doctor’s. If you want to be labeled as a “problem patient” bring a list to your visit.

    • http://www.facebook.com/rkopek Renee Kopek

      amen karen

      • Ginger

        I’d rather have Wi-Fi or read my book while I wait.
        If they want to have magazines or handouts with the information that’s OK, but for heaven sake don’t put it on a TV that blares.
        Once you’ve seen me if you have information specific to my problem, then I’m open to information and instructions.

  • Jane Infidel

    well said Karen3. I typed up a brief a brief explanation of my problem (I’m not well spoken) for an NP and she flipped out. It could not have been more than ten sentences. It was probably less. I also brought a letter from my insurance company explaining a medication that had been denied. She refused to look at it and accused me of trying to score more stimulants off of her, even though I was clear that the original med had been denied and she had to prescribe something else. I agree with you that they don’t like patients who are prepared.

    However, I will say this. English was OBVIOUSLY not her native tongue. And I read a review by a patient stating that his family had significant communication difficulties with her. I actually wonder now if she has trouble reading English.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Is there any research showing that this type of communication improves outcomes, or reduces costs, or at the very least improves patient satisfaction?

    If you want to put patients to work, and not necessarily right there in the waiting room, give them access to the EHR so they can click on all the boxes to record/update histories and ROS, and if you are adventurous maybe let them take a swipe at the HPI…..

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for the post Steve. Let’s name the elephant here. It is hinted to in the tone of resentment in your post title (hey, we are workin’ hard here, let’s put the patient to work too … yeah)

    The single most important determinant of the quality of your interaction with your doctor is how burned out they are on that hour of that day. As their stress rises, compassion fatigue and the ability to listen are the first signs. Research shows an average of 1 in 3 doctors suffer from symptomatic burnout … in some surveys the percentage is over 80%. You can hear this issue in the common patient complaints of “they didn’t listen to me”.

    You can’t give what you aint got. If your doctor’s physical an emotional needs are not being met … they simply cannot be there for their patients. So we can look at all the studies in the world about communication styles and if the doctor is trashed … not going to make a difference. INSTEAD, lets acknowledge that medicine is incredibly stressful (for everyone in healthcare NOT just the docs) and incorporate stress management and work life balance training into the education process.

    My belief is that a balanced doctor who is getting enough rest, nutrition, exercise and time with their family … naturally communicates at a more caring, collaborative and effective level. The question is how do we get there. Much of this whole communication issue is a simple reflection of burnout in the provider.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • http://www.mywhitecoatisonfire.com/ Lumi St. Claire

      Hey Dike-
      Just be aware that sometimes Kevin changes the title of the posts we submit to something that is “catchier”, so it may not have actually been the author’s choice.

      • http://www.thehappymd.com/ Dike Drummond MD

        Hey Lumi – I am aware of that. He has changed several of mine. AND the
        sentiment is common amongst doctors and staff when over stressed. It is
        one tiny taste of compassion fatigue. “I’m workin’ my butt off here …
        let’s put THEM to work for a change”.

        Balance and breathing and structuring your practice so that it does not
        completely dominate your life are keys … so you can be there with your
        patients.

        Dike

        Dike Drummond MD

        http://www.thehappymd.com

  • http://www.stephaniefrederick.com Stephanie Frederick, RN, M.Ed.

    Although my opinion might differ about how to engage folks, one thing I’m certain about….manage the TV! Nursing colleagues and myself initiated a “Relaxation Station” in a major hospital. Local photographers’ artwork, coupled with local musicians playing soothing music. Although it was an inpatient setting, the same holds true for an office setting. Yesterday I was in an office that had an active fish aquarium on the TV screen; I know the office next door has repeated “health tips” (no sound) that are updated regularly. If folks don’t have anything else to watch or read, chances are they might engage out of boredom.

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