Questioning a Taboo

Abstract

published a study 1 reporting that physicians interrupt patients, on average, after 18 seconds during an encounter. According to Google Scholar, 2 this study has been referenced 1115 times in academic journals and books, 50 times alone in 2016. The mainstream press picked up on this study with titles such as "Study Finds Doctors Aren't Good Listeners" or "Prescription for Doctors: Listen More."In light of the 1984 finding, how many students, residents, and practicing physicians in the last 30 years have been told not to interrupt patients? This admonishment is well intentioned. Most people associate interruption with rudeness, often leading to patient complaints. Skillful listening is essential to accomplish critical health care functions such as identifying the reasons patients request care, making accurate diagnoses, conveying empathy and support, exploring self-management challenges, and more. Yet there is a nagging question: Should physicians never interrupt their patients?Over the years I have asked scores of physicians and many psychotherapists, "Do you ever interrupt your patients?" I have received two answers: "Yes" and "Of course." Frequently the respondent laughs sheepishly as if to say, "I know I'm breaking a rule." What does the literature tell us about interruption in the medical encounter? Early research examining interruption of patients stressed physicians' tendency to assert and retain power in the relationship. Subsequent studies provide a broader, more nuanced view. Physicians and patients interrupt one another often, and patients interrupt at least as frequently as physicians. 3 Not all interruptions are intrusive, competitive, or power-claiming. 3 While some interruptions are classified as neutral, others build rapport, offer support, and express cooperation. 4 The frequency of interruption varies among visit phases. 5 The first phase combines rapport building and agenda setting. A middle phase focuses on diagnostic inquiry and hypothesis testing. The final phase is treatment planning. Physicians tend to interrupt in the earlier phases of the visit using questions to clarify symptoms or concerns. Later in the interview, patients may interrupt more often using statements more than questions. 3 Despite this research, writings and teachings claim that interrupting patients is taboo. Can some interruptions improve the quality of care and help the patient and physician make better use of time? I believe the answer is yes. Allow me to share a few examples from different situations when interruptions might improve health care efforts and decrease physician stress.

Lifestyle and Risk Factors in Hemorrhoidal Disease

“…Several studies have highlighted the importance of good interactions between physicians and patients. The evidence shows that by allowing the patients to discuss their problem without being interrupted for first two minutes, it is possible to optimize the visit time and obtain better results (27,28).…”

Developing Health Literacy Communication Practices for Medical Students

“…In preparation for the session and as a review of basic health literacy concepts from the previous year, students were asked to complete a preassignment (Appendix A), which included reading two articles 8,9 and watching a brief video. 10 The format of the 2-hour workshop, detailed in Appendix C, was (1) a didactic component that reviewed and taught three health literacy communication techniques through a 30-minute PowerPoint presentation (Appendix B); (2) modeling through a 30-minute whole-group live demonstration of a health literacy scenario;…”

Physicians Interrupting Patients

“…When an initial complaint is interrupted so quickly, the patient loses the opportunity to offer context to their chief complaint—their unique experience. It is unlikely that an interruption so early into the patient’s story is beneficial, even if it is to keep the patient on track, follow a verbal or nonverbal cue, or help organize the patient’s thoughts; all classified as beneficial interruptions by Mauksch . Derailing the patient in the first minute to corral them into the structure of the visit shifts the emphasis away from their story which, we believe, hinders an empathetic relationship and the ability to effectively diagnose and treat.…”

“…To the Editor Mr Mauksch highlighted how interruptions during the medical interview, which are commonly perceived as disrespectful, can sometimes be helpful by allowing patients and clinicians to work together . However, we believe that the timing, more so than the type of interruptions, deserves further attention.…”