One of the many lessons we are taught as physicians is to make a good clinical assessment and not to ask leading questions. If you direct the conversation, the thinking goes, you might miss important points in the history. In the real word, though, we all dread asking open ended questions that might open up the truth. We worry, in all honesty, that the patient might go on tangents if we start with something like “What brought you here today?” Why are we worried, though? Is it because we are not compassionate enough to listen to our patients? Or, is it that we feel so pressed for time that we have one eye on the door during patient visits? I guarantee the latter holds true for many of us.
When I was starting off as a resident, my biggest dissatisfaction with my patient visits was the lack of time I got to spend with them. I always felt like I had not given the patient the care that they deserved, and that they would walk out of the room dissatisfied. I had to obviously rush the visit because I had many other patients waiting to be seen. On one end of our spectrum, the world of healthcare today demands efficiency. On the other end, studies have shown that physician satisfaction is related to the perception of the amount of the time we spend with our patients and the relationships we have with them. From the patient’s perspective, time spent with the physician has a large effect on their satisfaction. How do you find a good balance, then, between the patients you want to treat and the endless piles of work that you have to finish each day?
I recently had the opportunity to analyze this from the patient’s perspective. I had to see two doctors for personal reasons, and I ended up being extremely satisfied with one and dissatisfied with the other. Leaving the medical aspects of each visit aside, I wonder, was time really the only determinant of my own satisfaction?
As I replay the first visit in my head, I remember the doctor had walked in, sat down on a chair — now on the same eye level as me — and started off with an open-ended question. He then did a very brief history and physical exam. He later spent a few minutes asking me about my profession. I felt a little gloating in my heart to tell him that I was a medical professional too. I guess I just wanted him to know more about me than just the body system that my presenting complaint was related to. When he was done, he gave me multiple cues to ask questions, and he looked patient, like he was not in a hurry to rush me out. He had turned multiple times to his computer to document notes, and I hadn’t seemed to mind that at all. Total time spent on the visit, 15 minutes. Did I want him to stay more? Hell no; I had to get back to work too and did not have all day for the doctor’s office.
The second visit was slightly different. The physician had walked in and asked an open-ended question, but he kept standing most of the time. Call me paranoid, but just the simple gesture of standing gave me a sense that perhaps he had to go somewhere else. There was no non-medical question asked. When I asked a question, I could sense a rushed tone to his voice, giving me a hint to maybe not ask more. Did he spend less time with me? He hadn’t. I kept track, and it was exactly 15 minutes. Was he less competent? I think not. Why did I end up walking out with the sense that maybe I should go to a different doctor next time? The answer to me was obvious.
These two visits have given me some great reflection on what may be important to patients when they go see a doctor. To my relief, time is not the only factor in this equation. It may be just one of many. Now, when I do a mental checklist of my own patient visits, I ask myself these questions:
· How often did I ask a patient or patient’s parent (I’m a pediatrician) a non-medical question?
· How often did I treat them as a separate individual, not just a patient or a parent?
· How often did I take the time to sit down?
· How often did I give them the lead to ask questions?
· Was I so focused on the disease that I forgot to look at the person?
In the past, when I didn’t do these things, I gave myself the benefit of the doubt and assumed it was because I didn’t have the time. There is no denying that as physicians, we do feel the pressure of time, but we sometimes forget that our patients may have been looking forward to their visit for a long time. Maybe we can make their visit more meaningful for them just by being more creative and present. After being on the other side, I can now see this with a different perspective. Can you?
Saba Fatima, MD, originally hails from Karachi, Pakistan and is currently training as a pediatrics resident in Philly. She has a passion for children and writing, and she hopes for a world where no child has to die because they cant afford to live. She is a 2018 Doximity Scholar. She tweets @SabaFatimaAli and blogs at https://sabafatimaali.wordpress.com/.