[No SPF Record] Re: [IMPROVEDX] This is NOT good news for Patient Engagement

Tom Benzoni benzonit at GMAIL.COM
Sat Aug 4 16:24:03 UTC 2018


We deal directly with this in SPAL teaching at our school.

However, I wonder why it's done. Like many observations, we each ascribe a
reason. We do so without knowing and thus commit attribution bias.

"Why" would be a very good study for the group to undertake.

Tom Benzoni

On Fri, Aug 3, 2018, 22:02 ROBERT M BELL <
0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:

> Is there any medical school in the world that deals with this in training?
>
> Would simulators help?
>
> Rob Bell
>
> On Aug 3, 2018, at 3:51 PM, Rory Jaffe <rjaffe at CHPSO.ORG> wrote:
>
> Interviewing patients is a real art—the only way I could see an accurate
> evaluation of good vs bad interruption is to videotape the interviews, then
> have a panel of patient advocates and clinicians score each interruption
> for its value.
>
> Because you can over-redirect—including premature focus on a particular
> aspect of the story, which may indicate that the clinician is jumping to a
> conclusion.
>
> Rory Jaffe, MD MBA, Executive Director, CHPSO <http://www.chpso.org/>
> 1215 K Street, Suite 930
> Sacramento, CA 95814
> rjaffe at chpso.org
> (916) 552-2600
>
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> *From:* HM Epstein <hmepstein at GMAIL.COM>
> *Sent:* Friday, August 03, 2018 2:26 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [No SPF Record] Re: [IMPROVEDX] This is NOT good news for
> Patient Engagement
>
> 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
>
> Website
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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
> Senior Fellow, RTI International
> Professor Emeritus, Stony Brook University, NY
> <image002.jpg>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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