For many clinicians, the constant pressure of budgetary and time constraints results in the need to do more with less.
The result is that many try to maximize these increasingly scarce resources by packing their clinic hours with as many billable interventions—and as much documentation needed to support them—as possible. This trend may at least partially account for the frequency of medical errors documented in United States medical settings.1
Although there’s a role for workflow fixes such as checklists2 and prompts within electronic health records3 to improve the accuracy and efficiency of our clinical services, refocusing on simple and time-tested basics is also necessary.
Start with Listening
When it comes to doing more with less, it doesn’t get much simpler than listening to your patients. To paraphrase Dr. William Osler, “If you listen to the patient, they will tell you their diagnosis.”5 While this statement originally applied to making an accurate diagnosis based on disease etiology, this timeless wisdom also applies to clinicians across all areas of medical care, speaking to the need to develop and refine the skills of listening for clinically relevant information.
Three Things to Think About
Want to become a better clinical listener for your patients? Start with these three steps:
1. Let Them Talk!
Data suggests that most people visiting a clinician have an average of eleven seconds of talk time6 before they are interrupted. Even as a health care provider, you have probably had the experience yourself of waiting a long time to see a clinician. And you may have also directly experienced the difficulty of getting your own story out.
Start challenging yourself to give your patients two minutes of uninterrupted talking time. Avoid asking clarifying questions early on because these can cause a patient to shut down and stop talking. Additionally, ensure that your active listening practices aren’t distracting your patients. While it’s good to let your patient know that you are engaged in the conversation, there’s such a thing as too much eye contact, head nodding, and vocalizations such as “uh huh.” Your patient may begin to feel self-conscious or think you are looking for an opportunity to jump in.
Although many clinicians express the concern that their patients will talk so much that they won’t have time to accomplish what needs to be done during the appointment, a little extra time up front can often save a lot of time later and even help you build a more effective therapeutic alliance with your patients.
2. Be Present
When you’re working with patients, you always have a number of details to process, both inside and outside the treatment room. One such major interruption is documentation.
Try taking notes when you’re finished with the visit instead of while you speak with your patients. You might find that the additional uninterrupted time during the visit results in extra time at the end of the session for documentation.
If this option doesn’t work for you, you can still improve your presence by looking up frequently from your computer or notepad. One good way to make sure you’re doing this is by consciously making eye contact throughout the visit.
3. Context Matters
How many times have you come across two people with a completely identical diagnosis but completely different needs and outcomes based on subtle differences? Without careful listening, you might miss these small but important details.
While the content of your conversations is important, you should also be taking in valuable context as you are listening. Clues that might inspire you to dive a little deeper include:
As you listen, strive to understand whether your patients might have unique needs9 based on the social determinants of health.
Want more information on creating, cultivating, and leveraging patient relationships? Make sure to check out the many courses on patient engagement, connection, and listening available through MedBridge, such as:
- Singh, H., Meyer, A. N., & Thomas, E. J. (2014). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving UW adult populations. British Medical Journal of Quality and Safety, 23(9): 727-731. doi: 10.1136.bmjqs-2013-002627.
- Gawande, A. (2007). The checklist. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2007/12/10/the-checklist.
- Ramirez, M., Maranon, R., Fu J., Chon, J. S., Chen, K., Mangione, C. M., Moreno, G., & Bell, D. S. (2018). Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a “chart closure” hard stop. Journal of American Medical Informatics Association, 25(9): 1167-1174. doi: 10.1093/jamia/ocy073.
- Kondro, W. (2010). Medical errors increasing because of complexity of care and breakdown in doctor-patient relationship, physician consultant says. Canadian Medical Association Journal, 182(13): E645-E646. doi: 10.1503/cmaj.109-3344.
- Bliss, M. (2000). William Osler: A Life in Medicine. Oxford University Press.
- Singh Ospina, N., Phillips, K. A., Rodriguez-Gutierrez, R., Castaneda-Guarderas, A., Gionfriddo, M. R., Branda, M. E., & Montori, V. M. (2018). Eliciting the patient’s agenda—secondary analysis of recorded clinical encounters. Journal of General Internal Medicine, epub. doi: 10.1007/s11606-018-4540-5.
- Junghaenel, D. U., Schneider, S., & Broderick, J. E. (2017). Linguistic indicators of pain catastrophizing in patients with chronic musculoskeletal pain. Journal of Pain, 18(5): 587-604. doi: 10.1016/j.pain.2017.01.001.
- Wilson, D., Williams, M., & Butler, D. (2009). Language and the pain experience. Physiotherapy Research International, 14(1): 56-65. doi: 10.1002/pri.424.
- Andermann, A., & CLEAR Collaboration. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association Journal, 188(17-18): E474-E483. doi: 10.1503/cmaj.160177.