How can I talk with my doctor if they are in a rush?

Patients who prepare for an appointment with their physician by reviewing recent medical notes and medical history,¹identifying and listing questions to be addressed during the visit,^2,3 and bringing the questions to the visit³ experience improved patient-physician communication and patient preference for involvement in care.^1,3-5 Patients communicating efficiently and effectively with their physicians have also demonstrated better health outcomes, such as a reduction in HbA1c^1,6 and increased quality of life with cancer diagnosis,⁷ through a variety of indirect (social support, patient agency and empowerment) and direct (exchanging information, making decisions, managing uncertainty) mechanistic pathways.⁵ Building meaningful patient-physician interactions is growing increasingly difficult with a consistent rise in patient caseloads over the last thirty years for both primary and specialty care,⁸ and the length of time that physicians visit with their patients varies significantly by discipline.⁹ Moreover, patient satisfaction and treatment and medication adherence is correlated to the length of physician visit, where longer visits have shown greater satisfaction and adherence.^10-12

While time constraints with physicians are often a concern and source of anxiety for patients, medical care has recently highlighted and emphasized a patient-centered approach. In this approach, patients experiencing more control over their health exhibit greater self-efficacy and sense of control in working with their physicians to make better medical decisions that impact other areas of their lives.^1-6,13 One intervention (n=59) aimed at increasing patient communication through information seeking found that when patients utilized negotiation skills the total volume of the patient-physician interaction increased. However the length of the visit was no different than other visits where patients did not play an active role.¹ In another study (n=53), women recruited in the waiting room of a physician’s office and directed to write down at least three questions to ask their physician asked significantly more questions than those who did not write down questions before their visit.³ Women who brought the questions in the exam room with them asked even more questions than those who wrote questions down but did not bring them in the room with them.³ In addition, women who planned to ask questions to the physician during their visit did not change the length of the visit, compared to the women who were not directed to ask at least three questions.³ These findings indicate there is a certain degree of flexibility in the structure and time allocation of medical appointments to accommodate patient questions and concerns that will not affect the length of the actual visit. Furthermore, patients encouraged to ask questions, review their medical record, and seek clarifying information from their physician experienced more satisfaction with the visit, greater sense of control, and enhanced quality of patient-physician interaction.^1,3,4

^References

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3. Thompson SC, Nanni C, Schwankovsky L. Patient-oriented interventions to improve communication in a medical office visit. Health Psychology. 1990;9(4):390.
4. Roter DL, Hall JA, Katz NR. Patient-physician communication: a descriptive summary of the literature. Patient education and counseling. 1988;12(2):99-119.
5. Street Jr RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient education and counseling. 2009;74(3):295-301.
6. Greenfield S, Kaplan S, Ware Jr JE. Expanding patient involvement in care: effects on patient outcomes. Annals of internal medicine. 1985;102(4):520-528.
7. Arora NK. Interacting with cancer patients: the significance of physicians’ communication behavior. Social science & medicine. 2003;57(5):791-806.
8. Mechanic D, McAlpine DD, Rosenthal M. Are patients' office visits with physicians getting shorter? New England Journal of Medicine. 2001;344(3):198-204.
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10. Geraghty EM, Franks P, Kravitz RL. Primary care visit length, quality, and satisfaction for standardized patients with depression. Journal of general internal medicine. 2007;22(12):1641-1647.
11. Frankel RM, Stein T. Getting the most out of the clinical encounter: the four habits model. Perm J. 1999;3(3):79-88.
12. Landau D-A, Bachner YG, Elishkewitz K, Goldstein L, Barneboim E. Patients’ views on optimal visit length in primary care. J Med Pract Manage. 2007;23(1):12-15.
13. Suarez-Almazor ME. Patient-physician communication. Current opinion in rheumatology. 2004;16(2):91-95.