Is your doctor really present during your visit?

During a recent visit to Dublin I was saw a neon sign in a pharmacy which read: “Doctor present.”

I was, first, amused by the wording. Dublin, home of George Bernard Shaw and Yeats and Joyce (and storytellers and bards in every pub) is a city with a deep and natural love of language–where even pharmacy signs are poetry.

But, next, I got to thinking. Am I “present” in my practice, even when I am in?

Though we all like to think of ourselves as exceptions when it comes to unflattering statistics, the likelihood is that I am not as present as I think I am or would want to be. If we define “presence” for a doctor as maintaining eye contact, paying close attention to what a patient is saying and not interrupting the statistics aren’t pretty.

An often-quoted 1984 study demonstrated that doctors interrupt patients within 18 seconds, on average. Despite more emphasis in medical schools on communication skills, that appalling figure hasn’t improved much.

Shorter office visits and computer screens in exam rooms haven’t exactly inspired doctors to be more contemplative.

Author and physician Abraham Verghese has urged physicians to slow down, and focus on looking at, listening to, and examining the patients in front of them.

My first day back after my vacation I had 20 patients on my schedule, and several phone messages to return from patients and their family members. One was a woman with traumatic brain injury, who speaks very haltingly. One was a patient who had many questions about a new diagnosis. One came in for a “quick” visit to check out a cough but started talking about her fears of dying of the same disease other members of her family had.

With that neon pharmacy sign flashing in my brain, I resisted my desire to speed up, to interrupt, to get through the day as quickly as possible. I found myself more relaxed than usual, and less exhausted by the enormous effort it requires to resist being present.

And guess what? I left the office the same time I always do.

Suzanne Koven is an internal medicine physician and a Boston Globe columnist.  She blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • Angelique

    Great essay! Some doctors are VERY fast to interrupt. What’s worse is that their receptionists don’t listen, either, and will schedule short appointments even after you tell them everything you need to discuss with the doctor.

  • Suzi Q 38

    I think that doctors just need to focus at who is sitting in front of them.
    Quit starting and at a computer screen or talking to the nurse.
    This is the patient’s time.

  • meyati

    When some interrupt, it changes the course of the discussion. I really love my electronic chart. I went in complaining of a possible secondary low-grade infection and low thyroid. He changed the discussion to the injury that hospitalized me and went into skin lotions for my dry skin. He seemed harried and flustered. I waited a few days, then I contacted him through my chart. I told him that the low thyroid really wiped me out, and dry skin is a sign of low thyroid. A few hours later, i had a new script.

  • rbthe4th2

    When you don’t get told a lot of your labs are low, indicating a serious illness, and no physical exam for those items are done, you know you didn’t listen to the patient.

  • http://www.zdoggmd.com ZDoggMD

    We can’t overestimate the importance to the therapeutic relationship of “presence.” This goes for physicians of course, but also for patients (get off that cell phone, yo!). I think we have to work on the systemic issues that distract us from patient care (poorly designed room setup, EMRs that make the HAL 9000 look friendly, insurance and administrative hassles, lack of team structures to support clinical activities). It can be done. And then we can truly be present with folks where they need us most: right here and right now in THIS current moment…which in the end is all we ever really have, right?

    • Maura69

      Yesterday I went to the doctor for a debilitating shoulder pain. I had called last week for the appointment and explained, to the receptionist, I had not injured the shoulder nor had any surgery on it – thus the appointment yesterday. When the doctor came in I explained that due to the pain on movement I am loosing the use of my right are and that the pain is radiating down to my wrist and hand. He said I needed an X-ray and to come back in two weeks. The order for an X-ray could have been ordered over the phone and thus he would have had the results now instead of waiting two more weeks. (I live 25 miles from the doctor and hospital) My shoulder is very close to being a frozen shoulder due to the pain. I go to the gym every day to keep myself from falling into the trap of unable to move. I have severe back, neck, hip and leg problems which the gym and exercise has kept me mobile but to travel to the doctor just to be told to get an X-ray and take pain pills in the meantime, to me, is appalling. This is a waste of my time, his time, office staff time and an unneeded expense for my insurance. I am so angry right now that if it were possible I would go to another doctor. What is your learned opinion???

      • http://www.zdoggmd.com ZDoggMD

        I’m not particularly learned, but I would say that better care coordination is in order! A team on the other end of that initial call could have coordinated this, perhaps with an initial telemedicine approach (even a Facetime visit), ordered the needed films, and then had a much more productive in-person visit. The problem is that our current fee for service reimbursement system really doesn’t encourage this (particularly non-face-to-face visits, which have minimal to no compensation for docs).

        In our upcoming clinic (Turntable Health, in Vegas), we function more on a membership model: your employer or you pay a flat fee (like a gym membership, around $75/month) for open access to the care team. No copays or obstructions to care. The team is motivated to provide care where YOU are without concern for insurance reimbursement. Telemedicine, email, home visits, whatever it takes to keep you healthy and minimize inconvenience.

        Things will change! In the meantime, best wishes for a quick recovery.

        • Maura69

          Thank you so much for your reply and I do believe a membership service would be quite appropriate. When my daughter was born, (1965) I had that type of medical care with the Pediatrician, (who had also been my pediatrician). This was a Pediatric Group and for a nominal yearly fee all was taken care of. If there were a serious problem the costs were not overbearing…

  • querywoman

    I’ve had some really bad docs, but I must be very lucky with my current crop. I’ve only had one doc answer a cell phone call during a visit.
    I’ve never had a doc stare at a computer screen. I do have one doctor who enters her notes in a laptop, but she looks at me plenty.

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