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Feature Stories

How can time-pressed doctors learn to really hear us?

Tom Laue, Executive Editor

How can time-pressed doctors learn to really hear us?

'I will remember there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.' (from Hippocratic Oath doctors vow to uphold)

Demand for your product grows. But customer service hiring can't keep up. So current customer service reps must make even more calls. They're also asked to work harder to treat customers as persons, not numbers.

Welcome to your doctor's world.
By 2025, 10,000 more primary-care doctors will be needed to meet boomer care, 9,000 more for Affordable Care Act needs, and 33,000 more due to population growth. (Annals of Family Medicine, Nov./Dec. 2012.)

What can time-pressed medical providers do to communicate faster in more compassionate, trusting, and human ways? After all, evidence suggests it helps doctors and patients. The Association of American Medical Colleges says the top attribute doctors must display is "compassion and empathy. They should seek to understand the meaning of patients' stories in the context of their beliefs, family, and cultural values."

Health systems experts weigh in

Thomas H. Dahlborg is chief financial officer and vice president of strategy at Boston's National Initiative for Children's Healthcare Quality. He's certain he beat a serious 2001 health challenge, largely because "my doctor shared ample time at each visit with me and my wife. He cared and empathized with us. Together, we created a 'care path' best suited for me and my family -- based on my whole story, not just a diagnosis."

Because of that, "I became passionate about doctor-patient relationships," says Dahlborg, who has a Master's of Science in (Health Services) Management (M.S.M).

"Ensuring physicians and patients have ample time to connect, develop relationships and trust, and for patients' whole stories to be heard is essential to optimal healing and saves health care dollars. As part of one such process, I was able to help create a model where primary doctors and patient-selected specialists would meet together with the patient and family and share ample time to create comprehensive care plans. This model addresses care, costs, and access."

This is one approach, Dahlborg believes, that comprehensively gets at a patient's whole story in a trust-filled setting and better positions patients for healing, while also improving clinicians' job satisfaction.

Another model is "shared appointments." One doctor meets a handful of patients with the same health challenge. This lets patients learn not only from doctors but from one another, reminds them they're not alone, and creates a healing community.

One doctor conducting shared medical appointments is Micah Chan, clinical chief of nephrology at the University of Wisconsin School of Medicine and Public Health. Patients with chronic kidney disease must keep up with their kidney data, diet, exercise recommendations, lab results, and dialysis options.

"In 20-minute one-to-one visits, you often don't have enough time to do all the education. But this way, patients learn a lot," says Chan. The American Academy of Family Physicians reports 12.7 percent of family doctors conducted group visits in 2010, helping reduce doctor stress.

'Lost soul for healing'

Dahlborg says, "Too often, doctors are taught to do things quicker and to stay detached, contributing to physician burn out. I know a primary care physician who had a burning desire to help people get well, but eventually, he told me, 'I've lost my soul for healing.' As a system we cannot afford to lose caring physicians."

In 12 years focusing on patient-centered care (Dahlborg's blog posts are at www.hospitalimpact.org), he sees progress but notes, "We still have a huge hill to climb. Most medical providers want to have human connections, but medical system barriers block them." In his December 2011 Hospital Impact blog, Dahlborg says reaction to an earlier piece ("Data shows most health care comes from relationships") was encouraging -- and disheartening.

"A patient widely viewed by physicians as non-compliant and morbidly obese found help and hope once a doctor took time to listen to her whole story and realized her unhealthy relationship with food was due to abuse issues," writes Dahlborg. "The patient was then directed to a professional who worked with the patient on her history of abuse and only when the patient felt ready was focus again placed on her weight challenge."

For tips on making the most of a doctor visit, click here.