In 1984 a study of doctor-patient interactions found that, on average, doctors interrupt patients 18 seconds into a visit. That finding has led to news stories painting doctors as people who aren’t listening to their patients.
An editorial published in the March 2017 issue of the Journal of the American Medical Association reopened the interruptions debate. Larry Mauksch, a professor in the Department of Family Medicine at U-W Seattle, argues that when you’re discussing health concerns with your doctor, there is good evidence you should be interrupted.
Mauksch frames interruption not as rudeness, but as skillful listening. Interruptions help doctors clarify symptoms. They help set the agenda for the visit, determining which health questions to make a priority.
Mauksch suggests that it’s not the number or timing of interruptions so much as the style of the interruptions that needs improvement. Mauksch describes interruptions that might improve patient care, which he labels the “Triple E” for “Excuse Yourself, Empathize, and Explain.” For example, when a patient begins rattling off a long list of problems a doctor might intervene by saying, “Excuse me. It sounds like you’re experiencing a lot of difficult symptoms right now. It seems like the headaches might be the most pressing issue to consider. Can you tell me more about those?”
A set of responses in a recent issue of JAMA disagree with Mauksch’s approach. James Kenneth Herstoff argues that the Triple E approach of agenda-setting unnecessarily rushes a patient and places too much emphasis on the physician’s time. A doctor who asks a patient to hold off talking about back pain while focusing on asthma symptoms, Herstoff suggests, sounds like, “Hurry up, the clock is running.”
Kari Ann Phillips and Naykky Singh Ospina are also paying attention to the clock, arguing that while Mauksch’s Triple E strategy is useful for improving patient care, it should not be employed in the first few minutes of a visit, time that should be spent building rapport instead of isolating problems.
Richard Frankel and Howard Beckman, authors of the original 1984 paper that Mauksch referenced in his editorial, also weighed in, pointing out that when physicians interrupt patients too early the patients may not reveal as many details about their health concerns, leading to incorrect or missed diagnoses.
What should patients take away from this debate about physician interruptions? First, patients should understand that doctors’ interruptions can be an important part of their medical care. The fact that doctors are arguing about whether and how long or often to interrupt patients should dispel the notion that doctors are insensitive to your time. They are not interrupting you because they are rude or insensitive to your concerns. They have studied the impact of interruptions on your health care and found that those interruptions might be awkward, but necessary. They are interrupting you to get the detail they need to properly address your concerns.
Second, patients can improve their care by being better agenda-makers. Makusch’s editorial and the responses it received demonstrated that doctors are interrupting you in part to set the agenda for your visit. Your doctor has the expertise to know which of your concerns require immediate medical attention, but if you don’t list your concerns, you may not give the doctor a good opportunity to help you prioritize your agenda. Write your concerns, in order, on one side of an index card. Start the visit by saying “I want to discuss these four (or five, or six) issues.”
Your doctor can then help you determine which issues to target first, and won’t have to interrupt you to figure out what to discuss next.
Third, patients should be more purposeful storytellers. If you’re nervous or in pain, it’s easy to rattle off a jumble of thoughts, ailments, and symptoms all before mentioning that you fell off a ladder a week ago.
One great way to limit the interruptions is to have a thorough answer to, “What brings you here today?” On the other side of your index card, write down all the details of your current health problem in chronological order. When did the pain start? How would you describe that pain? Does the pain change? What makes it better? What makes it worse?
Offering a clear description of your problem you helps ensure that all of your doctor’s interruptions will be the “good” kind: The ones that help focus on the problem so that you receive the best possible care.