I recently read an article that suggested physicians spend too much time talking about themselves during patient visits. Some of the examples were pretty outrageous, with the doctor chattering on about his own weight-loss success and running out of time before discussing the patient’s weight problem. The implications were pretty obvious: The patient could lose precious exam time.
I decided to do a little experiment in clinic. I would not talk about myself. I would reply to simple questions like “How’s the family” briefly (“Doing fine, thanks”) but no stories about the kids, no mention of what I did over the weekend, no prolonged discussions of why I decided to be a doctor, and so on. I would focus on the patient. Here’s what happened.
The first patient was an older man who I’d first seen about a year earlier.
“Hi, Sweetheart,” he said. “How’s the baby?” (I had been pregnant the last time he was in the office.)
“Fine,” I said. “How are you doing?”
“Oh, can’t complain. How old is he now?”
This was not going as I’d planned. “Not quite a year yet,” I said. “Have you been feeling OK? Any problems?” I avoided his eyes for a minute. I could sense what he was going to ask next, and it didn’t fit with my plan for the day.
“Do you have pictures?” he asked.
Second patient: a woman who was sitting, at usual, huddled into her seat. Doctors clearly made her nervous, and she had a right to feel that way: People like me had been giving her bad news for years.
“Hello,” I said. “How have things been going?”
“Are you kidding me?” she said, and pointed at her jacket, emblazoned with a huge team logo. “I’m waiting for the playoffs!”
I remembered that we had spent a good bit of time at our last visit discussing the players, the trades, and the prospects for the season. All that time that could have been spent making sure she was doing OK, making sure I wasn’t missing a new problem. Not today.
“Oh, yes,” I said. “Are you doing all right?”
But it was no use. We spent several minutes discussing the various local sports teams and their prospects for the postseason.
And so it went, with small talk often taking up the first five minutes of most of the visits. It was impossible to stop it from happening. And perhaps I am willfully blinding myself to the problems of spending those precious minutes in small talk, but I came to realize that those conversations help forge meaningful connections between doctor and patient.
If I remember a patient’s favorite team or the names of their grandchildren, perhaps I am showing them that I remember their medical problems. I like to think that the minor details I occasionally share about my own tastes and interests are more than a distraction.
I do worry, now that I am more aware of how often I “lose” five minutes this way, that patients might feel they must chat with me to gain my interest. It’s hard for me to know. Every meaningful conversation has to start somewhere, even if it’s about the weather.
Comments (1)
As a patient, I appreciate a ‘non-medical’ touch at the beginning of an office visit. A handshake works well for me. This brief pause for a seemingly small social interaction often relieves me of any ‘distancing’ that may have arisen betwwen my PCP and I since my last visit. I take it as an acknowledgement and appreciation of each other as a person. It enables me to be more open with him and I find myself able to approach the point of the visit more rapidly and in a more thorough manner.