A conversation in 12 minutes maximum
“Medicine is an art whose magic and creative ability have long been recognised as residing in the interpersonal aspects of the patient-physician relationship.” 1
It is generally accepted that the way in which a physician communicates information to their patient is as vital as the information being communicated. One of the first tasks in medical education is how to obtain a thorough patient history whilst establishing a good rapport with the patient and involving them in the discussion of their care.2
The value of the doctor-patient relationship acts as a cornerstone in clinical care and influences patient experiences within healthcare systems. However, a doctor‘s ability to empathise, clearly address the patient‘s presenting problems and comprehensively inform them on their current predicament in one sitting is often not as easy as it sounds.
The current climate of optimising workflows and reducing time spent with patients can lead to the treasured doctor-patient relationship being compromised.3 On average, it takes between 11 and 24 seconds before the doctor interrupts the patient for the first time. All the while, a typical consultation lasts just under 6 to a maximum of 12 minutes.4
Frustration for all involved
Frustration can manifest with such restrictions and ultimately everyone is dissatisfied. The doctor, because they have less and less time for patients despite overtime hours worked.4 The patient, most often because only a fraction of their concerns have been satisfactorily addressed.5 Would you like more figures? For example, in Germany according to estimates by the Ministry of Health, 9 to 15 billion euros are lost every year which can be attributed to insufficient patient health competence due to inadequate patient education and doctor-patient communication.6-7
And the human side?
All the above facts lend themselves towards one essential factor – good communication between the doctor and their patient is vital for mutual trust, respect and understanding for both parties.
Prof. Felix Unger, President of the European Academy of Sciences and Arts is of the opinion that the patient has been “degraded to an object” and stamped as a “customer in the healthcare system”.8 Yet, indirectly, another problem is highlighted – the financial incentives that pressurise the communication in the first place. Gertrud Demmler, a member of the board of Siemens’ company health insurance funds, describes it this way: “The doctor doesn’t earn money by listening, but through processing patients and conducting procedures”. In essence, the current remuneration system hinders listening in medicine with financial pressures looming in the background.8 Whilst most doctors yearn for additional time with their patients, this is proving harder and harder in many healthcare systems.
How does doctor-patient communication work?
Healthcare professionals want to offer empathy, compassion and respect for their patients and many have the ability to communicate effectively.9 Today medical education puts the concept of patient-centred care at the heart of its curriculum.
The “Shared Decision Making” concept is being increasingly taught in conjunction.10 The aim of the concept is to create the framework for a comprehensive exchange at eye level and on all aspects of health. Ideally, a conversation conducted in this way between the doctor and their patient enables the patient to make educated, consensus-based decisions regarding their health.
Theory and practice
The empowerment that effective communication can provide has a positive effect on patient motivation, satisfaction and complications.11 In addition, the physician in question encounters fewer legal proceedings brought against them.12–16 Such a functioning relationship can promote health and treatment adherence, thus reducing costs, however, there is a sizable catch.15–18 The time required is demanding.
This is uneconomic and, therefore, unrealistic in the everyday life of the clinic. So doctors must continue to try to identify the main issue troubling their patient as quickly as possible, potentially overlooking many others. As a result, the quality of care delivered can be perceived as being inadequate from the patient perspective.
What can be changed?
Could the situation be improved upon by enhanced payment for consulting services? Such a measure could certainly be appropriate, but even with adequate remuneration the effect would be marginal given the amount of patients to be seen and overtime already worked by doctors.19–20
An interesting observation in this context is that the duration of the consultation is not the sole determinant of patient satisfaction and wellbeing, but how well the time they spend with their physicians is being used.12, 21 This lends itself to the question: how can consultations be improved upon given the restricted time frames to better the patient‘s experience?
Digital tools to focus consultations
Digital solutions to improve the current problems in healthcare have been the focus of numerous start-ups and the digital departments of established healthcare providers for several years. However, the theory and practicality of such solutions can significantly differ in a bustling clinical environment which is why this is an evolving field.
However, we at heartbeat believe that it is a field with the promise of making better care possible. The commitment to higher quality outcomes begins early with our anamnesis and outcome measurement platform heartbeat ONE. During the consultation waiting period a patient can answer general and disease-specific questions. Whilst the results of this history and PROM collection are available immediately (both descriptively and graphically) for the consultation that follows.
This succinct presentation of what is concerning patients most can provide physicians with an overview and can go through the individual topics with the patient in a structured manner. This insight can lead to improved, focused communication between clinician and patient through asking specific questions without the patient feeling that they have not been given the opportunity to get a word in edgeways.
Of course, such software can never replace empathetic conversation and meaningful human support. However, it could make more effective use of the time available for the conversation and help to get the best out of the current situation for both doctor and patient.