What Happens When You Say Nothing at All?

by | May 18, 2022

I’m by nature an extrovert, people helper and a problem solver – after all, isn’t that why I became an optometrist?  I pride myself on my clinical skills and knowledge, and really feel proud when I have solved a patient’s problem or given them a proper plan as to what our next steps in their treatment will be. I start formulating the conversation and plan in my head (often before the patient has even finished speaking). I just can’t wait to share everything with the patient; won’t they be excited?

How many of you are just like me, brimming with knowledge and just waiting to wow our patients with an incredible exam room experience?  How many of us can’t keep that to ourselves and ultimately shout this out from the roof tops before we even let the patients speak?

How long do doctors typically listen to their patients before interrupting them?  Go ahead, I’ll . . . here is the answer!  11 seconds.  On average, doctors wait just 11 seconds before interrupting their patients. Count to 11 seconds- it’s not nearly long enough for a patient to accurately formulate their chief complaint, share what brings them into our office, concerns they may be having, questions they may want answered, or even just starting to talk about how they may be doing or feeling today. 

A study published in the Journal of General Internal Medicine analyzed 112 recorded clinical encounters between doctors and patients at general practices in Minnesota and Wisconsin, including the Mayo Clinic and its affiliates.  They evaluated how often providers asked what a patient’s concern was.  Shockingly, in only 40 out of the 112 encounters did a practitioner prompt the patient to see what brought them in, including asking “What can I do for you today?”, or “Tell me what brings you in today?”  However, even in these few instances when they asked the patient their concern, researchers found that physicians interrupted the patient 67% of the time, an average of 11 seconds after the patient began speaking. Some providers waited 3 seconds to interject (!), while some waited 234 seconds.  And nearly 60% of the time, the provider interrupted the patient to ask a closed-ended question, eliciting a yes or no answer.

What is the reason for this quickness to interject? Is it a time crunch situation? Are doctors trying to get patients to clarify their complaints and concerns quicker? Do we even realize we are doing this? What can be done?

For me, the first step towards a better patient experience in the exam room was simple recognition.  I credit Steve Vargo, Optometric Practice Management Consultant at IDOC, for my original understanding that this was happening.  I read his blog post and immediately became aware of my exam room entrance. I utilize scribes in my office, and they are amazing at helping me collect data and patient complaints and concerns. I noticed I would walk into the exam room and immediately start telling the patient how I was going to fix their problem(s) before they had spoken a single word!  Once I realized this, I began utilizing what I like to call “the pause.”

Using “the pause”

What is “the pause” and how does it help me slow down?  I’m extremely attuned to running on time and not keeping patients waiting. As my staff can attest, I’m also a very fast walker. I move quickly from exam room to exam room like a metronome, focused on keeping things running smoothly so no one has to wait. I now take a moment before entering the exam room to pause, take a breath, and put a smile on my face.  I enter the room, wash my hands, sit down, and face the patient.  I have a pretty good sense of why they are here, based on the information gathered by my technician, but I stop and ask each and every single patient, “what brings you in today?”  And. . . then . . . I . . . stop.

I close my mouth, clench my teeth, smile, sit on my hands, whatever I need to do to NOT INTERRUPT the patient and let them speak.  I don’t touch a pen, my computer, the penlight, the phoropter, or the slit lamp. I sit, facing the patient, and LISTEN. This is magic. The patients have an uninterrupted period to tell me everything they want to say about why they are here, and while I often want to ask questions to get more information, I stay silent until they stop talking. Now, I can chime in, elicit a more detailed response, ask probing questions, start to formulate a plan; everything we are trained to do and excited to share, but only after the patient has told me what they want to say.

I can’t do that!

But, Dr. Stewart, I’m busy! I don’t have time to let the patient speak. I can’t sit there all day!  One 500-bed, not-for-profit medical center in the Southeast really focused on teaching their physicians to have better communication and really stop to listen. They found the “exemplary” patient interactions, versus the normal, non-exemplary interactions, took only seven seconds longer for physicians. Can you spend 7 extra seconds with each patient for a better experience? I know I can.

What is the outcome of this patient centered approach? Patients who feel respected and listened to are more likely to stay with, follow and recommend their doctor. In a time when we are doing everything we can to attract new patients and increase our revenues, what is the value of an extra seven seconds of uninterrupted listening in the exam room? Can listening to our patients increase our optical sales, drive up our per patient revenue, garner more Google reviews and overall increase patient satisfaction? I encourage you to stop, breathe, listen, and find out.

Yours in success-

Jennifer L. Stewart, OD

By Jennifer Stewart, OD

Optometrist, internationally recognized speaker, writer, consultant, and entrepreneur.

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