According to a recent patient survey, the average in-office appointment is just 12 minutes long. In this short span of time, patients may experience some of their most monumental life moments, good and bad. They turn to physicians for their most personal and serious health issues and need them to listen, diagnose, treat, document, and explain in only 720 seconds.
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Physicians say these abbreviated patient encounters are what make the job worthwhile, yet patient face time accounts for less than 13 percent of a physician's day, according to Nuance, a market-leading provider of clinical documentation solutions. Many physicians find such little patient exposure frustrating, especially when a considerable portion of their time is spent integrating regulation changes and new technologies into their practices, which some feel strains the physician-patient relationship.
Physicians who question health IT might be surprised to find that 97 percent of patients are comfortable with technology in the exam room, and the majority of patients — 58 percent — believe technology positively impacts their care, according to a Nuance-commissioned survey of more than 3,000 consumers in the U.S., the U.K. and Germany.
The survey also found that most patients say communication is the number one factor that determines satisfaction in their healthcare experience. "Clear communication, responsiveness and follow-up are important," a survey respondent said. "Most physicians need to spend more time in discussion with patients and not rush the visit or discussions during a visit."
As healthcare delivery and patient expectations continue to change, crafting the best patient experience in that 12-minute window truly is an art form. Furthermore, as healthcare delivery becomes increasingly digital, it will be even more important for physicians to maintain the time-honored physician-patient relationship and understand what patients need and want out of their healthcare experience.
The state of physician-patient relationships
Patient expectations are high, but the good news is most physicians are delivering an excellent healthcare experience, according to the consumer survey. Almost 90 percent of respondents have a good relationship with their primary care provider and 95 percent are honest with their physician during appointments.
This means physicians are likely delivering on patient expectations of verbal communication, eye contact, and privacy, three of the top factors patients say matter most during visits to their physician. For German patients especially, privacy was a top factor in excellent medical care, meaning having extra support staff in the room was seen as negative rather than positive to their overall healthcare experience.
"Positive attitude, calmness, detailed explanations and friendliness are attributes of how a doctor should be," said one survey respondent.
The top contributing factor to better medical care for more than 73 percent of patients from all three countries was time for discussion, which ranked above verbal communication of specific recommendations, eye contact, and privacy. Yet 40 percent of patients feel rushed during appointments, with only 20 percent indicating they have never felt rushed during an appointment.
The survey found that an average visit is 20 minutes or less for 77 percent of patients. "There's not enough time to say what's wrong and discuss it in 10 minutes, especially if you have additional concerns or extra questions," said one survey respondent.
In the average 12-minute appointment, it is critical for physicians to make patients feel as though they have plenty of time to discuss diagnoses, treatment plans, and answer any other questions or concerns. Many physicians know the key to this type of time-bending is to move away from the door, sit down, make eye contact with a patient, and really listen to what they have to say. Twelve minutes of engaging conversation feels much longer than 12 minutes of indirect eye contact, distracted questioning, and a rushed or skipped physical exam.
Physicians who are able to make the patient feel like a priority will reap the benefits in more ways than one. After all, most patients — 52 percent in the U.S. — say they rely on word-of-mouth recommendations when selecting a provider.
How patient engagement shapes expectations
With limited time in the exam room and more consumer-driven choices in healthcare, patients today are increasingly engaged. Physicians can and should expect many patients to come to their appointments armed and ready with questions, concerns, and information from Internet research.
"Communication is the most important aspect of any relationship. Patients also need to be proactive in seeking information about themselves by researching online, reading magazines, watching videos, etc. You know your body (or should) better than anyone else," wrote one survey respondent.
Patients are changing the physician-patient dynamic by taking control of the limited time they have with their physician. Sixty-eight percent come to their appointments with a list of questions for their physician, according to the patient survey, and 39 percent have checked WebMD or an online source before their visit. Another 20 percent said they bring data from personal monitoring devices to share with physicians during their appointments.
Outside of the appointment, patients are becoming active consumers and personal advocates for their own health outcomes: About 80 percent of respondents say they feel engaged in managing their own health. This means patients are expecting physicians to step up to the plate and engage with them in the limited time they have together.
"I prefer/require my doctors to be open and happy to discuss my conditions with me, including any uncertainties or problems in my care management and treatment. If a physician is not willing to be open with me, I change physicians," explained one survey respondent.
Digitizing the patient experience
Emerging technologies present new challenges and opportunities for physician-patient communication. While many physicians may be wary of EHRs, most patients do not feel the same way, according to the survey.
"I perceive technology [in the exam room], if done right, as a positive," one respondent wrote. "It raises efficiency and improves data access and communication between physicians."
"I can see my medical record on my general practitioner's computer screen, including X-rays. This allows him to explain things more clearly," wrote another.
According to the survey, 69 percent of patients noted a difference in the amount of technology used by their physician in the last five years and 97 percent are comfortable with it, especially with the use of desktop or laptop computers. German patients were slightly more comfortable with computer usage (91 percent) than respondents from the U.S. and the U.K. combined (77 percent), but the majority of both groups said they feel comfortable with this standard piece of equipment.
Survey respondents felt less comfortable with the less common technologies , such as mobile devices, telemedicine tools, and interactive wearables such as Glass or smartwatches. Of respondents from the U.S. and the U.K., 27 percent said they felt comfortable with physicians using mobile devices during their exam, 18 percent felt comfortable with telemedicine tools and just 2.5 percent were comfortable with interactive wearables.
And while most patients — 58 percent — say they feel technology positively impacts their overall health experience, a small segment of respondents — just 3 percent — echo the concerns of physicians who are worried screens are negatively impacting the overall healthcare experience.
"While concentrating on filling out all the little spaces on the computer screen some valuable interactions and conversation gets lost," said one survey respondent.
Preserving the art of medicine
Technology will continue to be an increasingly significant component of care as adoption of various devices in the exam room continues to increase. While this may pull physicians in two directions at once as they juggle EHR requirements and limited appointment times, it will be even more critical for them to establish good communication techniques. Health IT should support the physician-patient relationship, not supplant it.
"Sitting side-by-side with my patients, I pull up the health record on my laptop and we review our notes," said Dr. Steven Schiff, MD, medical director of the Cardiac Catheterization Laboratory and CMIO of Orange Coast Memorial Medical Center in Fountain Valley, Calif. "I know they leave with a thorough understanding of their health status."
While patients appreciate the benefits of technology, they continue to value time for discussion, advice and recommendations, privacy and engagement during their physician visits. Maintaining a focus on these tenets of the physician-patient relationship will help physicians connect better with patients and more effectively improve health outcomes.
"Capturing the complete patient story while remaining focused on the human life at hand is what the art of medicine is all about," said William Kapp, III, MD, CEO and chairman of Landmark Hospitals and Technomad.