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Effective listening and an agreed understanding of the purpose
and limitations of the consultation have significant impact on time
management during patient consultations.
Communication is an essential part of health care. No matter how
knowledgeable the physician might be, if he/she is not able to open
good communication channels with the patient, he/she may be of
little or no help to the patient, with resultant little, or even
negative effect on health outcomes.
When a patient can talk freely at the beginning of a
consultation they will usually provide you with much useful
information about themselves and the effect of their illness or
In attempts to 'hurry the patient up', many doctors will
interrupt their patients before their patient has had time to talk
freely and thus the patient feels they have not been 'heard'. Yet
if the doctor was to give the patient 60 to 90 seconds of
uninterrupted listening then the patient will have been heard, and
will also feel they have been heard, and will have given the doctor
significant information to improve their diagnosis - indeed
patients will often, in these days of internet use, provide the
doctor with their own diagnosis, which can be surprisingly
accurate. Further, if the patient is uninterrupted for 60 to 90
seconds, then the patient's 'story/history' will usually have been
heard in far less time than if the doctor constantly (and
mistakenly) interrupts the patient in an attempt to shorten the
consultation time. Studies have shown that few patients will talk
for more than 90 seconds when telling their story.
Patients who feel they have been 'heard' are more willing to
follow advice and instructions, and are more willing to ask
questions or inform you of difficulties. Engagement of the patient
is key to effective consultations - this includes the opportunity
to be heard, an agreed understanding of the problem/s, an agreed
understanding on options and the next steps, and an agreed
understanding of limitations and expectations of treatment.
Effective communication has multiple benefits, including:
The 'Four Habits' model is the centrepiece of an approach taken
by one large health care organisation in the USA, Kaiser
Permanente, to enhance the clinical communication and relationship
skills of their clinicians. The model has served as the foundation
for a diverse array of communication programs. The goals of the
Four Habits are to establish rapport and build trust rapidly,
facilitate the effective exchange of information, demonstrate
caring and concern, and increase the likelihood of adherence and
positive health outcomes.
The Four Habits are:
Beckman and Frankel (1984) analysed how doctors' use of words
and questions can easily and inadvertently direct the patient away
from disclosing their reasons for wishing to see the doctor, and
Figure: Areas to improve your practice for patient
While it may appear that all these above steps will take up a
lot of time, how much you need to cover depends on if you are
seeing a new patient, a very familiar patient or someone you have
not seen for some time.
By spending a little extra time to get to know your patients,
you will find your interactions with them to be more fulfilling, as
well as more useful from a clinical point of view. In addition, by
feeling more in control of how you manage your time, you will be
looking after yourself better and will derive greater satisfaction
in the long term from your chosen profession.
Read the article: Recording Doctors' consultations