
Eliciting the Patient’s Agenda: Analysis of Recorded Clinical Encounters [pdf] - bookofjoe
https://link.springer.com/content/pdf/10.1007%2Fs11606-018-4540-5.pdf
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bookofjoe
Times change: when I was an intern in the ER at Los Angeles County-University
of Southern California Hospital in 1974-75, "5 minutes or 5 problems —
whichever comes first," was our guideline.

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robbiep
That’s really interesting - I’ve never heard that.

I only work ED these days and only a few shifts a month, but I love the
interview. And I also hate the interview.

When I have worked 60 hrs a week it’s easy to develop compassion fatigue: it’s
just so hard listening to story after story and allowing someone to just tell
their story.

I want you to tell me in your own words, and I want to know what the root
cause was that lead you to the department, and how long that bit went on for,
but if I don’t cut you off and prompt you for some really weird specific
details that aren’t necessarily going to roll out of your mouth. You’re the
70th patient this month and I’m currently juggling 4 stories around in me head
at once - I can’t get too involved with you.

So - there my experience anyway

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maxxxxx
A while ago I joined my girlfriend for a few doctors' visits because of
chronic pain. I definitely noticed that with most of them it's really hard to
get a word in. You go in, they ask what the problem is, barely listen for a
few moments, order tests and then proceed with what they want to do. It feels
like the patient is just a thing that needs to be processed as quickly as
possible.

I don't recall a single visit where there was a real exchange between patient
and doctor.

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asimpletune
> clinicians elicited patient concerns, the clinician interrupted the patient
> after a median of 11 seconds (interquartile range 7–22; range 3 to 234 s).
> Uninterrupted patients took a median of 6 s (interquartile range 3–19; range
> 2 to 108 s) to state their concern.

I’m not sure what conclusions to draw from this. On one hand, I find that
people who interrupt me make whatever I need to say take much longer. On the
other hand, I feel that patients would be shy when answering, if they were
asked broad questions, and therefore take less time to answer, possibly hoping
for more guiding questions to follow.

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oceanghost
Most medical advice is designed to minimize liability, not actually help
patients. Doctors don't need to listen, and can't.

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forapurpose
The fundamental problem I see is that doctors treat patients as threats to be
managed: They will take too much time, they might sue, they will misinform
you, they tire you out (per another comment). That's not a healthy attitude
and it doesn't lead to productive relationships.

My experience with doctors is that they are unprofessional: Their
communication skills are poor, causing potentially dangerous misconceptions
(someone mentioned a secret 5 minute rule; what if critical info is in the 6th
minute?), and a lack of understanding on my part (they barely listen so they
don't know the question and therefore don't answer it); they are
disrespectful, often treating patients like mentally challenged children (5
minutes and that's it, and we won't tell you there's a time limit), have no
regard for patients' time[0], and won't return phone calls or emails; they are
often sloppy and often unprepared, which I know from personal experience[1]
and from the fact that hospital errors are a leading cause of death (at least
in the U.S.).

Doctors behave as if they are the only ones challenged by constrained time, by
communicating with clients, and by weariness at the end of the day. But every
other profession, from lawyers to accountants to IT consultants, has the same
problems and deals with it. My lawyers and accountants master communication
skills, respect clients, and are productive. I want to say: Grow up, be a
professional, I don't give f- that you're tired and busy, so am I. Every other
profession manages.

[0] I'm busy too; I have people waiting for me too; how about if I make you
sit around for an hour in the middle of your day? Doctors commonly schedule
patients to come before the doctor will be ready, to make sure the doctor
doesn't have to wait - as if their time is more important than mine. They fall
behind schedule every day, making patients wait - after the third day, you
learn and adjust your schedule; after three years, it's just complete
disrespect for patients' time. One doctor I had to see regularly for awhile
would schedule me at 8:15 and wander in at 8:45 with a bagel, coffee, and
reading the news. Another schedules his entire day at the same time in the
morning, and patients just sat around the waiting room all day; after 2 hours,
I asked others and the nurse, found out what was going on (and that it was his
standard procedure), and left; the woman waiting for hours in a wheelchair
with an oxygen tank and nurse apparently didn't have that option.

[1] Just off the top of my head: Seeing a doctor for a second opinion on a
serious back problem. When the doctor walked in, opened the file, and started
reading, I told myself she was just refreshing herself. Her advice was for the
wrong problem in the wrong part of my back; when I tried to tell her, she
didn't listen and when she finally realized it, she just tried to cover for
herself.

~~~
just-to-reply
I'm sorry you have had bad experiences with physicians.

But not every other profession has the same problems. I have been on call for
12 days in a row where anyone who tells my answering service they are a
patient of our office can call anytime to ask any question, no matter how
ridiculous, for free. Today I have returned calls to a patient who is pregnant
but concerned that she does not feel enough pregnancy symptoms and someone
whose temperature is 99.8 and is concerned.

I am almost always in the office before my patients arrive, often as much as
two hours, doing charting. I am signing forms to get people FMLA. We don't
charge for filling out these forms. Do you think your lawyer would?

Frequently patients are late, but then still want to be seen. So either I make
the late patient angry, or everyone else behind them is angry.

How many lawyers get called all night long? How many accountants are at their
place of business in the middle of the night?

I have a nurse to return phone calls, but it seems that hardly anyone can have
a voice mail that it set up, and due to HIPAA regulations we are advised not
to leave any personal messages anyway. So we pay a whole office full of people
to play phone tag all day.

Sometimes I am late, but sometimes people are unexpectedly trying to die.
Sorry I never met this lady who has 2 liters of blood in her belly, so I
didn't know she was going to come to the ER with her ectopic pregnancy today,
and inconvenience you. We do try to call and reschedule, but again can't
always get through.

~~~
forapurpose
I know your frustrations, because I see the same things in IT and other
professions. The difference I see is that doctors seem to think they are a
special case (in this and other things) and helpless to manage these issues;
the truth is that they are a common case and that there are solutions that
other professionals commonly use and are expected to use.

All that you describe is common for IT professionals (support and system
administrators), and sometimes with just as much on the line or more (large
amounts of money, careers, and sometimes even lives). I know some who have
been on call for years in a row, and when they travel outside of cellular
coverage they rent a satellite phone. They have no nurse to return calls; when
someone calls (or a system sends an automated alert), they logon and get to
work.

They work all hours; all-nighters and 7 day workweeks are common. One sysadmin
I know estimates one all-nighter per month. When a deadline is approaching,
you can count on 100+ hour weeks. Just read HN to hear people talk about it.

Their customers (users) have the same absurd requests, same demands, same
communication problems, etc., though of course about different topics. For
example, some send ambiguous problem reports and don't respond to attempt to
clarify - but if the problem isn't fixed, money will be lost and you know who
will be blamed!

Their scheduling problems are the same: Unpredictable issues arise and always
at the worst time. That means they have to schedule with a large margin for
error.

> How many lawyers get called all night long?

I know many who do. First, some have clients in many time zones around the
world and most have clients around the country (in the U.S., the latter means
a 5am-6pm minimum workday on the west coast). More often, they are working on
urgent projects and must respond ASAP to the other attorneys and clients
working on the issue lest they delay everyone else or, worse, fail to
contribute value and influence the outcome.

As for accountants, in the U.S. ask them what tax season is like.

