This is NOT good news for Patient Engagement

Nick Rainey nickraineydpt at GMAIL.COM
Sat Aug 4 15:04:08 UTC 2018


I agree with Michael. What the patient actually cares about is if the
clinician actually understands the reason for them being there. The stat of
interruption may not be a correct indicator of what they're attempting to
really measure.

On Fri, Aug 3, 2018, 7:12 PM Michael H. Kanter <Michael.H.Kanter at kp.org>
wrote:

> So I think the bigger issue is not the interruptions as they could be
> either useful and appropriate or not so.  The real issue in this paper is
> that the patient’s agenda was not elicited over about 2/3 of cases.
>
>
>
> *From:* Elias Peter <pheski69 at GMAIL.COM>
> *Sent:* Friday, August 3, 2018 3:14 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] This is NOT good news for Patient Engagement
>
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> A ‘clarifying’ question that turns the patient narrative into a series of
> yes/no or checklist questions would be an interruption. However, the
> following clarifying questions would not be:
>
>    - Hmmm. I’m not sure I understand. Could you tell me more?
>    - How was that for you?
>    - What did you think that meant?
>
>
>
> Peter
>
> On 2018.08.03, at 5:26 PM, HM Epstein <hmepstein at GMAIL.COM> wrote:
>
>
>
> The question is whether the term “interruption” is the patient’s term or
> the researcher’s. If my doctor asks me a clarifying question, I do not
> consider that an interruption but if they redirect me with an question
> unrelated to what I’m describing I do. This is one more example why we need
> engaged patients and/or patient advocates involved in the design of every
> research project.
>
> Best,
>
> Helene
>
>
>
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> On Aug 3, 2018, at 4:28 PM, Joe Graedon <jgraedon at GMAIL.COM> wrote:
>
> Great point David,
>
>
>
> So how would we 1) distinguish between “good interruption” and “don’t care
> interruption”?
>
>
>
> and
>
>
>
> How can we drill deeper into this issue so that we would have meaningful
> data?
>
>
>
> Joe
>
>
>
> On Aug 3, 2018, at 3:50 PM, David Newman-Toker <toker at JHU.EDU> wrote:
>
>
>
> I guess I’ll push back a little on this, Mark. I have always been a little
> concerned that people spontaneously equate “interrupting” with “not
> listening,” or, worse yet, “not caring.” I can see the logic of these ideas
> being associated, and I’m sure that some clinicians interrupt their
> patients thoughtlessly because they have their own agenda and don’t care
> what the patient is interested in telling them. However, I’m not sure this
> concept really applies when it comes to good diagnosis. A typical
> diagnostic encounter in my clinical domain goes something like this…
>
>
>
> DNT (asks an open ended question): “So, tell me what happened when you
> first got your dizziness symptoms?”
>
>
>
> Patient: “Well, I was at home this morning. I got dizzy, so my husband
> called 911. Then the ambulance arrived, and they put me in the back, and
> then they put in an IV, and gave me some fluids. Then I arrived at the
> emergency room and Dr. Smith told me I had an ear infection. He gave me a
> medicine… I can’t remember the name, but I think it started with an ‘M’.
> Then they admitted me to the hospital because I was too sick to go home….”
>
>
>
> DNT (interrupting after ~10-20 seconds of the patient’s story above): “Ok,
> hold on a minute. Let’s go back a bit to the part where you first got
> dizzy… Where were you? What were you doing?” … (waits for answers) … “Did
> you feel unsteady on your feet? How did you get from the hall to the
> kitchen… Did you crawl? Hold on to the wall?” … (waits for answers)… “Were
> you sick to your stomach? Did you vomit?” … and so on …
>
>
>
> I just think that *active* listening to the patient’s story means
> redirecting them to the information that is most pertinent diagnostically…
> and that often means interrupting frequently with more narrowly-focused or
> closed-ended questions than the ones you began with. In my view, this is
> what patients should be looking for in a caring, thoughtful diagnostician.
> That’s because it is very rare for a (lay) patient to be able to so
> cogently and concisely tell their illness history that it simply rolls out
> perfectly over 5-10 minutes while the clinicians politely takes notes for
> the record in complete silence. I just think there is another side to this
> issue of “patient engagement” and dialogue.
>
>
>
> For what it’s worth, patients can readily tell the difference between
> someone who interrupts because they want to understand what happened… and
> someone who interrupts because they don’t care what the patient has to say.
>
>
>
> Best,
>
> David
>
>
>
>
>
>
>
> *David E. Newman-Toker, MD PhD*
>
> Professor of Neurology, Ophthalmology, & Otolaryngology
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> *From:* Mark Graber <Mark.Graber at IMPROVEDIAGNOSIS.ORG>
> *Sent:* Friday, August 3, 2018 2:46 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] This is NOT good news for Patient Engagement
>
>
>
> There have been earlier studies showing that clinicians tend to interrupt
> the patient at the start of the encounter.  At a time when patient
> engagement and partnership are strongly being endorsed, one would have
> thought we’d be doing better by now.  I guess not !
>
>
>
> Here’s a quote from a new study, attached:  “The patient’s agenda was
> elicited in 36% of the clinical encounters. Among those in which the agenda
> was elicited, patients were interrupted seven out of ten times, with a
> median time to interruption of 11 s.”
>
>
>
> Mark
>
>
>
> Mark L Graber, MD FACP
>
> President, SIDM
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> Senior Fellow, RTI International
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> Professor Emeritus, Stony Brook University, NY
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> <image002.jpg>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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