Rx for time-crunched physicians

July 14, 2008

With their waiting rooms crowded and exam rooms full, many physicians say they are too busy to be good communicators. Those who study physician time-management think otherwise. Certain communication skills can foster efficiency and effectiveness during an office visit without sacrificing rapport with patients, according to researchers at the University of Washington (UW) and the University of Rochester.

Their guide to a smoother flow of communication between doctors and patients appears in the July 14 issue of the Archives of Internal Medicine. Their model is based on the authors' observation: "Effective communication in primary care must include skills that enhance the quality of care while helping patients and physicians use time wisely... Making the best use of available time is important for visits of any duration."

The researchers are Larry Mauksch, a UW behavioral scientist in family medicine who studies and teaches doctor/patient communications; David C. Dugdale, an internal medicine physician and director of the UW Hall Health Primary Care Center; Sherry Dodson, UW clinical medical librarian; and Ronald Epstein, professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry and its Center to Improve Communication and Health Care.

A few of the lessons the researchers presented in the resulting article, "Relationship, Communication, and Efficiency in the Medical Encounter: Creating a Clinical Model from a Literature Review" are:

First, focus the purpose of the visit with the patient: Instead of addressing each issue as it surfaces, creating a list at the start enables the doctor to confirm which problem is most medically urgent or most important to the patient. This approach also reduces the "Oh, by the way" issues brought up at the end of the visit.

Then, understand the patient's perspective: Exploring the patient's viewpoint is useful for promoting self-management, suggesting healthy changes, assessing motivation, learning the patient's family and cultural beliefs, understanding the social and psychological problems that are diminishing the patient's ability to function, or getting to the root of medically unexplained symptoms.

Near the end, reach a mutual agreement on a plan: The physician and patient decide on approaches the patient is willing to follow to manage or prevent the health concerns explored during the visit.

Throughout the office visit, it's helpful for physicians to: "Visits with the doctor that contain these fundamental elements," Mauksch said, "lead to greater patient satisfaction, better adherence to medical regimes, increased self-management, better health outcomes, lower costs, and fewer malpractice claims. These skills enable physicians to do it right the first time, so they don't have to do it over."

"We've tried to propose a model of doctor/patient communications," Dugdale added, "that is at the intersection between what patients need and the reality of a doctor's world. These are skills that make a difference and that doctors can use throughout their entire careers."

Some Facts on Doctors' Office Visits

Teaching Doctors-in-Training How to Do Office Interviews

Patient communications are addressed in medical schools and residency training programs, but after starting practice, many new doctors abandon what they learned.

Larry Mauksch, who is on the faculty of the UW Department of Family Medicine, said it's difficult for medical students to learn doctor/patient communications only through classroom lectures or reading. Medical student training at the University of Washington (UW) includes observations of actual, enacted and Web-taped doctor visits.

Trainees use checklists to monitor specific parts of a medical encounter and they learn to put a name to specific skills. Students rate video demonstrations that are missing core communication elements and identify strategies for improvement. They also observe one another to help each other learn. Communication skill building is a key component of the UW medical school's introduction to clinical medicine course for second-year medical students and the family medicine clerkship for third-year medical students.

Some senior medical students take a clinical clerkship that concentrates on patient-centered communication. Mauksch likens the method he uses to the training of an athlete or a musician, where students have many opportunities to try out their skills, get comments, and try again, with refinements.

"Students experience for themselves how specific communications skills help them avoid pitfalls in patient interactions and make better use of time," Mauksch said. "They see themselves becoming more effective and enjoy their work more."
-end-
UW Medicine/UW Health Sciences News & Community Relations
University of Washington
Box 358046
South Lake Union UW Medicine Complex
815 Mercer St.
Seattle, WA 98109
206-543-3620

University of Washington

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.