How to make sure she's focused during your office visits It's important that a doctor is good in more than the technical ways. My first year of medical school included a class in doctoring, where we were videotaped and then graded on our performance. But our grades weren’t based on medical proficiencies, such as arriving at the correct diagnosis. Instead, the emphasis was on how well we paid attention, listened, and responded to what our patients were saying—basic skills every physician should develop. In the years since, there have been many changes in healthcare, and your doctor's care may reflect some of them. For example, electronic health records (EHRs), email, and text messages have become ever-present distractions. And the list of regulatory requirements, meant to show we’ve met quality standards, improved care, considered cost, and used technology meaningfully, is growing longer. As a result, I often find myself looking at my computer screen instead of my patients’ faces. And as you might know from your doctor's care, I'm not alone. A Northwestern University study published in 2014 in the International Journal of Medical Informatics found that primary care doctors who used EHRs in the exam room spent about one-third of the time looking at them. Doctors who used paper charts looked at the documents for 9 percent of their patient’s visit. And a September 2016 report in the Annals of Internal Medicine found that for every hour doctors are face-to-face with patients, almost two more are devoted to EHRs and desk work. How Distraction Can Harm You The current system puts doctors in a time (and attention) crunch. The possible results? If your doctor is trying to attend to your EHR in the midst of your office visit, his or her focus may be divided. That, of course, can affect your doctor's care. And according to the Northwestern study, when doctors used EHRs in the exam room, they were more likely to miss important nonverbal cues. Overlooking them can make it more difficult for doctors to arrive at a correct diagnosis. The following steps will help ensure that your doctor's care is focused where it should be. Check Attentiveness Doctors strive to be as attentive as possible. But the reality is that we are distracted by competing agendas these days. For example, a patient came to me last year in distress because her long-term physician, out of the blue, had asked whether she was being physically abused. She wasn't. He was probably trying to comply with a requirement that he document the percentage of patients over age 65 who had experienced maltreatment. Doctors are being asked to record a host of similar “quality care” measures and, although well-intended, they often divert us from the problem at hand. To determine whether your doctor is engaged, note whether she is asking appropriate questions during your visit. Reflective questions—such as “How long has the pain been present?”—are a good sign she is listening and considering what you are saying. Think about whether you’re getting enough time to express your concerns as well. Body language offers other clues. An attentive doctor will try to make eye contact, face you squarely, lean forward, tilt his head toward you, and nod in agreement. Make Sure You're Heard To keep the focus where you want it, take these four steps: Plan before your visit. Decide what you are going to say; write it down if you need to. Present your top two or three complaints, emphasizing what’s bothering you most and why you are there. Bring a friend or a relative. He or she can help you remember what you want to say, take notes, and ask questions. Sum it up. Just before you leave, the doctor should recap your diagnosis, the tests or procedures to schedule, and treatments or medications prescribed. If she doesn’t, do so yourself. Repeating and rephrasing what you’ve heard can give you confidence that she understood what you said. This information should also be included in the patient summary you receive as a printout or by email. Speak up. Nothing gets my attention more than a patient who lets me know I’ve been sidetracked. Most doctors appreciate it when a patient says, “You seem distracted today; I don’t feel like you’ve been listening.” We want you to feel heard, and we all need a reminder now and then when we’ve failed. Source
