Blog | Thursday, May 3, 2012

Why doctors interrupt

A few weeks ago I called a neurosurgeon to discuss a patient's recent headaches. My patient had been seen in the emergency room several days prior with the worst headache of his life. A complete work-up had not revealed a cause for the headache. Although he was found to have a small aneurysm on CT angiogram, there was no evidence of bleeding by lumbar puncture. The story, however, was slightly more complex than this.

There had been several other findings that remained unexplained. One of the findings led me to discuss the patient's case with a cardiologist. My patient had also undergone cervical spine decompression surgery several months prior to treat cervical myelopathy. I wanted to engage the neurosurgeon and get his professional opinion about my patient's headache, which had now recurred several days after his ER visit.

The surgeon was cordial, but about 5 seconds into my story he seemed inpatient and interrupted me. "I heard about this guy," he said, "What he needs is to be seen by one of our neurovascular specialists." I had more I wanted to say, but the doctor did not seem to want to listen. I raised my voice slightly, interrupted him before he had a chance to end the conversation, and bulldozed through, telling the rest of the story in about two minutes. "Now we're talking," he said, as I explained further about a family history of clotting and my concern about a dural thrombus as a potential etiology. Together we formulated a plan that I was satisfied with, though the interaction left me with a feeling of unease.

Interruption is a pervasive communication style with doctors. In a well-known study by Beckman and Frankel patients were allowed to complete their opening statement expressing their agenda in its entirety in only 23% of physician interviews. The average time to interruption was 18 seconds. This study's findings have been replicated by several others.

In a more recent study of primary care residents, patients were allowed to speak for only 12 seconds on average before they were interrupted. Female patients experience interruption more frequently than males. In contrast, studies have suggested higher rates of patient satisfaction with physician visits during which patients and doctors interrupt at similar frequency and also with visits in which there is more "reflective" silent time during the conversation. Perhaps the tendency to interrupt extends to all physician derived professional communications, as in my case with the neurosurgeon on the phone.

Why do physicians interrupt? In practical terms, throughout the course of a given day a physician may be tasked with listening to 20 to 30 patient derived histories and with solving difficult problems for each of these patients in a matter of 10 to 15 minutes. This is a tough, if not impossible job. Consequently, once a physician believes that the meat of the story is out there, he or she may respond and interrupt before hearing details that the patient (or colleague) feels are important. In more abstract terms interruption is a communication strategy that reinforces physician dominance in the hierarchy of the patient-physician relationship.

The most frequent complaint that I hear from patients about other physicians is that a physician did not "listen," or did not "seem to care" about their problem. My advice to physicians and medical trainees: sit down, bite your tongue and wait. If you do interrupt, do so with brief questions allowing your patient to return to his or her agenda. You might be surprised and learn something, and no doubt you'll certainly have happier patients (and colleagues).

Juliet K. Mavromatis, FACP, is a primary care physician in Atlanta, Ga. Previous to her primary care practice, she served on the general internal medicine faculty of Emory University, where she practiced clinical medicine and taught internal medicine residents for 12 years, and led initiatives to improve the quality of care for patients with diabetes. This work fostered an interest in innovative models of primary care delivery. Her blog, DrDialogue, acts as a conversation about health topics for patients and health professionals. This post originally appeared there.