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Ever feel rushed during a doctors visit? You weren't imagining things. If you were lucky enough to be asked why you are there for help, chances are you were only given a few seconds to do so.
In a new study published in the Journal of General Internal Medicine titled, “Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters,” researchers discovered that the primary prerequisite for patient-centered care -- namely, doctors asking their patients what’s wrong and listening to them -- is dismally absent. On average, only 36% of patients were given an opportunity to share why they were there. And in the about 1 in 3 who were asked to share their reasons for seeking medical help, they were only given 11 seconds on average before being interrupted.
The paper begins by pointing out how indispensable it is that physicians elicit patients concerns in order to practice compassionate and therapeutic medicine:
“The medical interview is a pillar of medicine. It allows patients and clinicians to build a relationship. Ideally, this process is inherently therapeutic, allowing the clinician to convey compassion, and be responsive to the needs of each patient. Eliciting and understanding the patient’s agenda enhances and facilitates patient-clinician communication.”
Despite this, there is a long history of research that supports the present study’s concerning findings:
“In a landmark clinical communication study published in 1984, Beckman et al. found that in 69% of the visits to a primary care internal medicine practice, the physician interrupted the patient, with a mean time to interruption of 18 s. Fifteen years later, Marvel et al. found that physicians solicited the patient’s concern in 75% of primary care visits and interrupted this initial statement in a mean of 23 s. Similarly, Dyche et al. found in 2004 that in approximately 60% of general medicine visits, the clinician inquired about the patient’s agenda, that only 26% of the patients completed their statement uninterrupted, and that the mean time to interruption was 16.5 s.”
The researchers were surprised to learn that there findings were even worse than what the previous literature showed. In their words, “We found that interruptions occur extremely early in the patient’s discourse and that patients are given just a few seconds to tell their story.”
They concluded: “[T]he results of our study suggest that we are far from achieving patient-centered care, as barriers for adequate communication and partnership continue to limit the elicitation of the patient’s agenda and lead to quick interruptions of the patient discourse.
The Absence of Compassion In the Practice of Medicine
The study discussed above represents only the tip of the iceberg when it comes to modern medicine's fatal lack of concern for the patient's first hand experience. One of the origins of the problem is in the way doctors are trained. There is a surprisingly consistent body of research exists indicating that conventional medical training actually reduces practitioner empathy. What is worse, the decline in empathy appears even more pronounced at the time that the curriculum shifts towards patient-care activities.
In one study published in 2009 in the journal Academic Medicine titled "The devil is in the third year: a longitudinal study of erosion of empathy in medical school," the authors conclude:
"It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential."
In another, higher-powered systematic review published in the same journal last year entitled "Empathy decline and its reasons: a systematic review of studies with medical students and residents," researchers looked at data from 1990-2010, which included 18 studies, and found:
"The five longitudinal and two cross-sectional studies of residents showed a decrease in empathy during residency. The studies pointed to the clinical practice phase of training and the distress produced by aspects of the "hidden," "formal," and "informal" curricula as main reasons for empathy decline."
"The results of the reviewed studies, especially those with longitudinal data, suggest that empathy decline during medical school and residency compromises striving toward professionalism and may threaten health care quality."
While the ironic decline of empathy associated with clinical practice during medical training is cause for concern, what may be even more disturbing is that the decline in empathy persists after training has ended.
In a 2005 study published in Academic Medicine and titled "Mood change and empathy decline persist during three years of internal medicine training," researchers noted that some of the mood disturbances and declines in empathy associated with residency/internship "never fully recover," indicating that conventional medical training may produce real, diagnosable psychological traumas that may never be fully resolved and may adversely affect the quality of healthcare provided.
Empathy, after all, has concrete and measurable therapeutic effects in others. In 2009, researchers found that practitioner empathy reduced the duration of the common cold in their patients. Conversely, a negative and/or indifferent attitude towards the patient has measurable adverse effects, also known as the nocebo effect. Indeed, our recent article titled, "Research: Some Cancer Diagnoses Kill You Quicker Than the Cancer," discusses the finding that the risk of suicide is up to 16 times higher and the risk of heart-related death 26.9 times higher during the first week following a cancer diagnosis versus those who were diagnosed cancer free.