Home / Insurance Products & Risk Mgmt. / Knowledge Base / Articles Published by MICA Staff / Article Detail

Too Busy to Care?

Revenue down. Patient volume up. Managed care, Medicare and last, but not least, patient care. Have the long hours and many pressures of medical practice taken the “care” out of your “patient care?”

A survey of 11,000+ DOs and MDs published in the October 8, 2004 issue of Medical Economics Magazine reports family doctors and internists see an average of 20 – 25 patients a day or 100 – 120 patients a week. Strangely enough, the same survey shows these doctors are actually seeing fewer patients and working fewer hours per week than they were in 2001. This seems to be true regardless of specialty.

Interestingly, physicians in midsize and large groups actually worked more hours than those in solo practices and offices of two to three physicians. The median work week of primary care doctors in 2004 is 50 hours, just what it was the prior year. That plateau is a far cry from the 55 hours doctors averaged in 2001, however. Furthermore, data show that primary care doctors in rural areas work 55 hours a week, five hours more than their urban and suburban colleagues. But that's down from 60 hours a week in 2001.

Unconvinced by such numbers, physicians continue to FEEL incredibly busy and overwhelmed whether on a good day (fewer patients) or bad. Whether it’s the pressures of the bureaucratic hurdles or the increased demands of patients, for some doctors it has translated into a reduction of “caring” in the delivery of patient care. The results are slipping patient satisfaction scores and a growing public awareness of medical errors. Physicians, too, report being less satisfied. And when there is a medical error, a physician whose patients’ feel “cares less” is much more likely to be labeled careless in a subsequent lawsuit.

Somewhere along the line, many physicians began to resent patients and attribute to them much of the pressures of the business of medicine. Putting the caring back in patient care has as many benefits for the physician as for the patient. But where do you begin? At no identifiable point did you suddenly decide to stop caring; for most it was a gradual decline from a practice that was rewarding to one of apathy or even resentment. How do patients measure caring, anyhow?

When was the last time you laughed during a patient interview? Studies show that physicians who used humor and laughed more often were less likely to be sued than their more serious colleagues. The non-sued physicians also encouraged patients to tell their stories in their own way, really listened and asked patients their opinions.

"My doctor doesn't listen to me" is a perennial complaint in patient satisfaction surveys and focus groups. Anecdotal reports and academic research are full of evidence that patients of doctors who listen well have better clinical outcomes. Communicating well with patients makes for fewer telephone inquiries, encourages good word-of-mouth about your practice, and keeps malpractice lawyers at bay. It also cuts back on the need for corrective action, since your patient is less likely to mistakenly take three pills once a day rather than one pill three times a day.

Patients want to be treated as individuals; they want to be respected and listened to; they want their humanness acknowledged. But the “art” of medicine, we are told, is now a luxury. It is not in the budget. At least this is the message we are sending. We often let time constraints rush us through the patient interview, missing critical information and frustrating our patients. Senior citizens may present an even greater challenge. Failing to hear what our patients are trying to say leads to unnecessary phone calls and office visits, Communication is vital to gather information necessary for a proper diagnosis and to ensure the patient is compliant – fully invested in obtaining the best possible outcome. And it is the only way the patient has of judging that we care.

So how can you show patients you care while quickly and efficiently gathering the data you need for diagnosis and treatment? It doesn’t cost you anything to remember to sit down with your patients and converse eye to eye while you are gathering information. A recent study demonstrated that patients’ estimates of visit times were much longer when the clinician sat down and conducted the interview at eye level. Eye contact enhances trust. Studies show that when a physician averts his/her gaze to the chart the patient questions whether they are listening. Make eye contact while the patient is speaking and wait for natural pauses to make your chart notes.

Use appropriate touch to show you care. Shake hands; place a comforting hand on a shoulder or elbow. Patients come to you in varying levels of distress and apprehension. Even a routine check up can be anxiety provoking for many. Whether a pat on the hand or a practical expression like offering a tissue or glass of water, providing comfort is a key role expected of physicians and other healthcare professionals.

Let the patient talk without interruption. When patients are allowed to speak without interruption, they are likely to reveal important information and to take no more than two extra minutes to do so. Probing hints that the patient drops also shows you were listening. Be sure to elicit the patient’s expectations for the visit early on and incorporate that into your agenda, even if you need to prioritize to focus on critical issues.

Ask at the end of the interview, ask: "What else is on your mind today?" This can avoid the "Oh, by the way," statement that patients often put off until the end of the interview. Frequently, it is during these last-minute statements that patients reveal the real reason they are seeing the doctor.

No matter how busy you are, listening skills and other effective communication techniques make sense. It is these skills that show that you care about the patient as an individual, not just a slot in your appointment book. You’ll find that taking a little extra effort to demonstrate caring to patients will make them more satisfied, more compliant and more likely to show improvement. In turn, you may find you actually do care and even enjoy going into the office again.