In your latest medical encounter, did your doctor shake your hand, look you in the eye and start a two-way conversation? Or, did he or she cut straight to the chase, reeling off questions from on-screen checklists and inputting data into an ever-present laptop? Doctors are working under more pressure than ever before. Even so, patients deserve their undivided attention. If you're taking second place to a computer screen, experts explain why that is and suggest how to take back your time. Less Time for Empathy Recent changes in health care – such as ramped-up productivity requirements, increased documentation and new quality metrics – have contributed to "tremendous" time pressure for doctors, says psychiatrist Dr. Helen Riess, the chief scientific officer of Empathetics, Inc. Almost inevitably, that affects doctor-patient relationships. "So many of my patients were dissatisfied by the quality of the office visits with their physicians," says Riess, who is an associate professor of psychiatry at Harvard Medical School. "They really didn't feel the care that was supposed to be a part of health care." In 2011, Riess founded Empathetics, which provides empathy training for clinicians based on the neuroscience of emotions and empathy. "Our solution is really to embed personal skills," she says. "How to read facial expressions, how to look for patients' chief concerns – not just their chief complaint." Many patients feel reluctant to bring up their dissatisfaction in real time, Riess notes. "Patients could really benefit by learning to say, in a polite way, 'I worry that when you're looking at the computer I'm not getting your full attention,'" she says. It's OK to ask: "Can we just have a conversation between the two of us before you type into the computer?" Data Deluge Complete, updated patient information – from CT scan reports to blood pressure trends to medication lists, available right at the fingertips of every health care team member – that's the promise of electronic health records. So the data-input process is a necessary evil. Patient data points entered in by doctors in the EHR are also used for quality measurement. Hundreds of health care quality metrics now exist. Health data collection and reporting comes at huge manpower costs, as detailed in an April 2016 article in Medical Economics. "Clinicians and their staffs are spending about 15 hours per week, per doctor, to enter a hodgepodge of quality data into computers," the authors noted. One partial solution: The profession of "medical scribe" sounds medieval, but this emerging field is one way to streamline doctors' workloads. Scribes, who may be medical students, shadow health care providers throughout their shifts, and let them offload tasks such as entering patient notes and data into the EHR. Maxed-Out Providers Nationwide shortages of primary care doctors, specialists and nurses put added pressure on those left holding down the fort. "In my area there's a very big need for primary care doctors," says Dr. Linda Girgis, a family medicine physician in South River, New Jersey. "It's really hard to turn patients away when they call in sick. We've stopped taking as many patients as we used to, but people have no place to go so they have to get squeezed in somewhere." While the ballpark office visit time is about 15 minutes, Girgis says, patients get as much time as they need. "There are all kinds of complications when seeing patients," Girgis says. "They come in with multiple problems that take up more time, which pushes the whole schedule back. Other patients coming in after them may feel like they're more rushed." In the wake of the Affordable Care Act, patients and doctors' offices alike must grapple with changes in insurance coverage. With some patients finding network plans with high deductibles, Girgis says, "they obviously get frustrated when they come to learn that insurance is not paying anything." Changing Workplace The vision of hanging out a shingle and starting a solo practice is fading for today's doctors. "Most of that has gone away," says Dr. Lotte Dyrbye, a professor of medicine and co-director of the Physician Well-Being Program at the Mayo Clinic. "Most physicians are employed by a larger organization." In the trade-off, Dyrbye says, doctors gain administrative support, for instance with Medicare regulations, but lose significant control and flexibility over how they work. These changes don't necessarily make for a nurturing workplace. "Physicians are running so fast from room to room, and completing documentation requirements and quality reporting metrics, that what's gone to the side are those two-minute, around-the-coffeepot conversations, or connecting with colleagues in a way that's face-to-face and that really facilitates social support," Dyrbye says. Physicians talk about feeling overloaded, overwhelmed and socially isolated, Dyrbye says. They, too, are frustrated at losing face-to-face time with their patients. It could be much better. "People who have a lot of social support at work tend to have more satisfaction with their job," Dyrbye says. "They're more engaged." Recognition of clinician stress, burnout, high turnover and mental health risks is growing, Dyrbye notes. One response is an effort launched in 2017 by the National Academy of Medicine. Known as the Action Collaborative on Clinician Well-Being and Resilience, its goal is to reverse trends in clinician burnout. Patients can help by being understanding, Dyrbye says. That could mean realizing if you leave a voicemail or send a message to your doctor via your web-based patient portal, you probably won't hear back right away. Source
