Anyone who's made a customer-service call in the past few years knows that the opening 10 minutes of the ordeal entails an option-selection frenzy intended, I presume, to teach us the value of self-reliance and solving our own problems. And no matter when you last called, you can be sure that "our options have changed."

Those who persist and are rewarded with an actual human encounter will recognize the latest tack that marks the end of every such interaction: the final series of questions designed to establish beyond any reasonable doubt that there is nothing else we can do for you and we have, indeed, met your every need today.

I don't want to be cranky so I'll admit that there is a germ of a well-intended idea here. While the customer-service call and the medical visit are enormously different encounters, there may be some value for physicians in this good idea gone haywire.

Research centered at Wilmer Eye Institute recently looked at communication patterns during routine visits between 23 physicians and 50 patients with glaucoma. The visits were videotaped and questionnaires were completed post-visit by physicians and patients.

Predictably, the physicians controlled the conversation, speaking 70 percent of the words and asking two-thirds of the questions during the visits, which lasted on average about eight minutes. Virtually all of the physician questions were closed ended. Patients and physicians were in alignment that such control of the encounter's agenda by the physician is appropriate. But is it always effective? Maybe not.

Of the 13 instances in which a post-visit questionnaire revealed a patient who missed medication in the previous week, the physician questioning uncovered just three.
Interestingly, this group of patients was also less satisfied with the encounter.

While the report (still pending formal publication) did not specify the number, the authors report that "a minority" of physicians ever asked the patients if they had any questions.

Somewhere short of the smarmy excess of "Have I anticipated and fulfilled your every whim today?" there has to be room for, "Do you have questions?"

 

Friedman DS, Hahn SR, Quigley HA, Kotak S, et al. Doctor-Patient Communication in Glaucoma Care Analysis of Videotaped Encounters in Community-Based Office Practice. Ophthalmology 2009 Sep 8. [Epub ahead of print].