July 2020 Communication Tip

Not Interrupting + performer: Rahul Aggarwal, MD

Periodically in this monthly column, I feature pearls of wisdom from a cancer center colleague of ours who is widely-recognized as a great communicator.  This month, I wanted to share advice from Rahul Aggarwal, MD, a genitourinary medical oncologist and newly appointed Associate Director for Clinical Research.

Rahul told me: “I try to have the patient do the majority of the talking in the first 5 and last 5 minutes of the visit” and “I ask at least three times if the patient has any additional questions/concerns before concluding visit.”

Strategies to invite patients to talk can include:

• Responding to a patient’s talk with “conversation continuers” such as nodding or saying something like “ahhh” or “uh-huh.”
• Explicitly inviting additions with statements like “anything else?” or asking for elaboration with statements such as “Oh…  That sounds important.  Can you please tell me more?”
• Asking “open-ended” follow up questions, rather than “yes/no” questions.
• Responding simply with silence (inviting the patient to say more)

Us clinicians have room to improve.  One recent study (Ospina et al, Eliciting the Patient’s Agenda—Secondary Analysis of Recorded Clinical Encounters, JGIM, 2019) suggests that

• Clinicians set an agenda in only about 1/3^rd of encounters
• When asking about patient concerns, specialists typically interrupt their patients within just a median of 11 seconds (range 3-234 seconds)
• Although sometimes it feels like patients may keep on talking forever uninterrupted, research suggests otherwise:  uninterrupted patients typically don’t go on very long at all when stating their concerns, a median of 6 seconds (range 2-108 seconds)

Giving patients adequate time to tell their story (or at the very least, set an agenda for a visit), typically “pays off” in the long-run with greater trust, a better history, and higher patient satisfaction.

Best,

Mike