Why Some Patients Aren't Following Your Instructions

Neil Chesanow


May 29, 2013

In This Article

How Much Extra Time Will This Take?

When Medscape's 2013 Physician Compensation Report was subdivided into 25 Specialty Compensation Reports, it was clear that not just primary care physicians but also many other specialists try to see patients in 15-minute visits. That's typically with minimal, 1-size-fits-all communication, without using teach-backs, reframing, brown bag reviews, visual aids, and other tools and feedback loops to ensure that patients understand how to adhere to their regimens.

When you're on that tight a schedule, if you let your patients speak without interruption, encourage them to ask questions, and go out of your way to ensure that you are understood, won't your office visits get a lot longer?

Research shows that this concern is greatly exaggerated. In 1 study, patients who were allowed to talk without interruption for as long as they liked spoke for an average of only 1 minute and 40 seconds.[6] In another study, patients were permitted to voice their initial concerns at the beginning of an office visit, again for as long as they wished without interruption. The mean spontaneous talking time was only 92 seconds, with a median value of 59 seconds.[7]

"Yes, it's a new way of communicating," Osborne concedes, "but once you know how to do it, it becomes a habit. It really doesn't take more than a minute or two."

Spending just a small extra amount of time with patients also reduces your risk for being sued for malpractice. The AMA handbook notes that "data from multiple US states indicate that primary care physicians who have been the target of malpractice liability claims spend an average of 15 minutes per patient on routine visits, while physicians who have never had a malpractice claim against them spend an average of 18 minutes. This is a difference of a mere three minutes."[2]

An even more fundamental reason to make clear communication with patients a priority in your practice is that your effectiveness as a physician hinges on it. Studies show that effective patient communication has a beneficial effect on medical outcomes. These include lower rates of anxiety, pain, and psychological distress, and higher rates of adherence and symptom resolution.[8] Patient adherence to treatment regimens is strongly influenced by a physician's communication style.[9] A doctor's clear instructions are associated with improved rates of adherence.

Making sure that your instructions are clear may take a little more time. But if it helps to reduce the number of times the patient needs to see you, has to go to the emergency department, or gets admitted or readmitted the hospital, it's time well spent.


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