Family physicians are under growing pressure to increase the rate at which they see patients. This pressure comes primarily from third parties such as managed care plans, whose administrative demands have decreased the amount of time available for face-to-face contact between patients and their physicians. At the same time, third-party payers are increasingly surveying patients about their degree of satisfaction with their physicians and are using the data to evaluate physician performance. One of the most common patient complaints is “my doctor didn't spend enough time with me.”
How can you reconcile the pressure to see more patients more quickly with the need to maintain patient satisfaction? The Direct Observation of Primary Care Study [see “Illuminating the ‘black box’ of primary care”] examined this question by asking patients the degree to which they were satisfied with the amount of time their family doctors spent with them. Using the Davis Observation Code, researchers also looked at how time was spent during outpatient visits with 2,315 adult patients.
Researchers found that satisfaction with time spent was strongly correlated with longer visits and, when length was controlled for, satisfaction was correlated with several factors beyond the physician's control: greater patient age, white race and better perceived health status, for instance. But satisfaction was also correlated with at least one factor very much within the physician's power to influence: Even a brief amount of “chatting,” defined as nonmedical talk, was associated with greater patient satisfaction with the time spent with the physician.
In addition, providing patients with feedback on the results of the physician's evaluation was also associated with greater satisfaction with time spent, but only during longer visits (visits longer than 15 minutes). During brief visits (those of less than 5 minutes), providing patients with such feedback actually decreased patient satisfaction with the amount of time spent.
The results bring to light two take-home lessons for increasing patient satisfaction with the amount of time you spend with them:
First, spend a brief amount of time connecting with each patient as a human being, rather than just a patient. This can be accomplished easily by chatting about a nonmedical topic, such as the patient's job, hobbies or children. In the study, the average amount of time family physicians spent chatting was less than 45 seconds.
Second, when providing complicated feedback about the results of an evaluation, take enough time with your explanation so that the patient truly understands. If this is not possible, consider delaying feedback until there is sufficient time to allow the patient to absorb the information and ask questions without feeling rushed.
These two techniques can help you diminish the common complaint that “my doctor didn't spend enough time with me.”
Illuminating the ‘black box’ of primary care
This article continues our series offering practical lessons from the Direct Observation of Primary Care Study, which was funded by the National Institutes of Health and conducted by the Research Center to Investigate the Value of Family Practice, with support from the AAFP. The study demonstrates the complexities of the patient visit, the demands of real-world practice and the value of primary care, issues that policymakers, the public and even clinicians have not fully understood. Researchers used a multi-method approach, including direct observation, to study 4,454 patient visits to 138 family physicians in 84 practice sites.