Doctors are impatient. We understand why. They are being pushed by office managers to see more patients in less time. That means they often feel like hamsters on a treadmill. In fact, some physicians have taken to calling this treadmill medicine. One result is that many doctors interrupt patients before they have a chance to tell their whole story. What are the ramifications of 11-second interruptions?
The 60-Second Stop:
A study published in the Journal of the American Academy of Orthopaedic Surgeons, Nov. 1, 2023 was quite revealing. These were patients in the Department of Surgery and Perioperative Care at the University of Texas, Austin. They were dealing with musculoskeletal problems, which can be quite complex.
The researchers analyzed transcripts of 194 patient-clinician interactions. The median visit lasted 12 minutes. The authors write that:
“The median duration between the end of the initial greeting and the first interruption was 60 seconds.”
In some cases the interruption came within 30 seconds.
“Clinician interruption was associated with shorter duration of symptom description.”
When patients cannot tell their whole story without being interrupted, the doctor may not truly understand what is going on. That can lead to misdiagnosis. You may want to read our in-depth analysis of why that is so critical at this link.
Interrupting Patients Is Nothing New:
Over 30 years ago a landmark study published in the Annals of Internal Medicine (Nov. 1984) reported that on average, physicians interrupted their patients after only 18 seconds. The authors noted:
“Determining the patient’s major reasons for seeking care is of critical importance in a successful medical encounter. To study the physician’s role in soliciting and developing the patient’s concerns at the outset of a clinical encounter, 74 office visits were recorded. In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement of concerns. In 51 (69%) of the visits the physician interrupted the patient’s statement and directed questions toward a specific concern; in only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement…The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.”
Fast Forward to 2001:
A study of medical residents behavior published in Family Medicine (July-August, 2001) reported that:
“Patients spoke, uninterrupted, an average of 12 seconds after the resident entered the room.”
The Conclusions:
“Numerous interruptions occurred during office visits. Gender was associated with the pattern of interruptions. Physicians frequently interrupted patients before the patients were finished speaking. Computer use also interrupted physician-patient communication.”
You may not be surprised to learn that “Female residents interrupted their patients less often than did male physicians.”
It wasn’t just the doctor interrupting the patient. The researchers noted:
“Verbal interruptions, a knock on the door, beeper interruptions, and computer use all interfered with communication, and increased frequency of interruptions are associated with less favorable patient perceptions of the office visit.”
Are You Tired of Doctors and Computers?
We were glad that the researchers noted that doctors typing on computers also interfered with communication. But keep in mind that was published in 2001. In those days doctors did not have to use computers. Now, virtually all doctors have to use a computer to enter patient information into the electronic medical record. We think that this can be a tremendous impediment to good communication.
The 2018 Update on How Doctors Interrupt Patients:
A study published in the Journal of General Internal Medicine (online, July 2, 2018) assessed 112 doctor-patient interactions between 2008 and 2015.
The researchers report that:
“the clinician interrupted the patient after a median of 11 seconds.”
That’s right, 11 seconds! Imagine trying to describe to your lawyer a serious legal matter in 11 seconds. Isn’t a medical problem at least as important as a legal problem?
Why Are Interruptions Bad Medicine?
The authors of the study introduce their research this way:
“The medical interview is a pillar of medicine. It allows patients and clinicians to build a relationship. Ideally, this process is inherently therapeutic, allowing the clinician to convey compassion, and be responsive to the needs of each patient. Eliciting and understanding the patient’s agenda enhances and facilitates patient-clinician communication.”
The authors note that the results of their study demonstrated that:
“patients are given just a few seconds to tell their story.”
If patients are not interrupted, they normally complete their story in 92 seconds. That seems totally reasonable. Yet few physicians can sit patiently and wait for a minute and a half while a patient describes why they have come to the doctor’s office.
Specialists Were the Worst:
Specialists were less likely to ask patients about their concerns and agenda than primary care doctors.
The authors conclude:
“the results of our study suggest that we are far from achieving patient-centered care, as barriers for adequate communication and partnership continue to limit the elicitation of the patient’s agenda and lead to quick interruptions of the patient discourse.”
That’s a diplomatic way of saying doctors interrupt patients far too often and far too quickly. We suspect that most physicians would be upset if patients interrupted them after only 11 seconds.
We do understand that doctors are being pushed harder and harder. Time constraints are burning out a lot of well-meaning physicians. But that is no excuse for interrupting a patient after only 11 seconds.
What Do You Think?
Share your perspective in the comment section below. We would LOVE to hear from physicians, nurses and other health professionals.
