Scenario 1: You’re in the exam room, sitting in an open-backed gown. You and your doctor have discussed your high blood pressure (stay on the same medication) and your diet (you reluctantly agree that you need to try to make healthier choices to control cholesterol). Your doctor makes a note on the computer screen, jumps up, and heads to the door. With a hand on the doorknob and a “see you next year,” your doctor is about to disappear. Bam! Out the door!
“Wait,” you say. “I have more questions.” But your twelve-minute visit is over, and you never mentioned the blood in your stool, and you meant to ask about the funny mole on your back.
Scenario 2: You’re in the exam room, sitting in an open-backed gown. Your blood pressure and weight were taken by the intake nurse. In breezes the doctor who looks at the lab work and decides to up your dose of a statin drug for your heart.
You say, “I saw a commercial about taking CoQ10 for my heart.”
And the doctor says, “Oh, those darned commercials. Patients come in here all the time wanting this drug or that supplement.”
“So should I take CoQ10 because I take a statin?” you ask.
“You don’t need it,” the doctor says as the door slams behind her.
Unanswered questions. Missed opportunities. Short visits. No explanations forthcoming. What’s wrong with some healthcare providers and doctors today? Why won’t your doctor listen to you?
Does any of this sound familiar?
Where have you gone, Dr. Marcus Welby?
Medicine is at the crossroads of disintegration in the delivery of clinical care despite incomprehensible advances in surgery and in the management of conditions that were once deemed to be hopeless and fatal. Some patients with stage IV cancer, far advanced, can be cured by designer drugs and precision medicine. The revolution in robotics and in laparoscopic technologies has transformed surgical management of some conditions.
Nevertheless, there is a crescendo of frustrations and criticisms among patients seeking care. So where do we go from here?
You need to become a highly empowered patient.
The Invisible Partners in the Exam Room
Imagine a bunch of invisible partners in the exam room with you. One is the behemoth insurance company. With the insurer’s stopwatch monitoring the length of each visit, you’ll be lucky to get your precious few minutes.
At the same time, your provider is being pressured by the medical practice to see more patients — like Lucy and Ethel in the chocolate factory trying to keep the conveyor line moving. Add to that the burden of the electronic medical record in which the doctor is required to do all kinds of technological acrobatics to get your health information into the system.
Key point here: Doctors often spend more time in front of a computer than in front of the patient. It didn’t use to be that way. And at the end of the month they will use “pajama time” to catch up. This means feeding the computer at off hours, which can take 20 extra hours a month, in my experience.
And who among us healthcare providers has the residual bandwidth to meaningfully engage with concerned patients and families in view of this digital dragon of the electronic medical record siphoning off doctors’ time and energy?
The doctor in the mouse
A 2024 survey found that your doctor spends nearly 6 hours in front of the electronic health records (EHR), leaving notes, for every 8 hours of patient scheduled time. No wonder your doctor wants to hustle you out of the exam room. Primary care doctors spend even more time, at 7.3 hours, updating your records — more than half of their workday.
I have seen data that in a 10-hour shift in the ER, the emergency physician will perform over 4,000 mouse clicks. Yes, those EHRs are helpful and efficient, but at what price?
Let’s do the math. Primary care docs might see between 11 and 20 patients a day (although some see up to 60). And the average amount of time in the exam room with each patient is 17 to 24 minutes on a good day. There just aren’t enough hours in a day, especially when you’re the one sitting in a gown watching the clock, waiting for a tap on the door.
And if seeing patients in person is not exhausting enough for clinicians, patients are emailing and using the portal. Some medical offices are now charging patients to respond to email questions especially if those questions involve reviewing the medical record to prescribe medication. Some providers view the portal as patients asking their advice and treating the service like a free Google search.
The explosive, almost cataclysmic increase in medical knowledge is another factor taking away your doctor’s time and attention. Who can keep up? The body of medical knowledge is doubling almost every 73 days, and in some circumstances, the engaged patient will have more factual knowledge about their illness than does the provider who struggles to keep up with the latest in medical journals — thanks to information-rich patient portals and medical databases open to anyone who cares to ask Dr. Google.
And now AI (artificial intelligence and machine learning) are totally changing the medical landscape. Platforms that are relatively easy to use can empower patients to ask questions about their diagnosis and care. And in seconds the “answers” will be printed out. But hold on, the answers may be incorrect. The “robot” is not always reliable.
The burned-out physician is more typical today than in the past when the friendly family doc made house calls and took a chicken in payment.
The new reality in the exam room
Is your doctor hustling you through the exam? Yes. Does your doctor care about you? Probably. But circumstances don’t allow the doctor to do what doctors do best and that’s listen to the patient and make thoughtful decisions about care. I am referring to what is called decision fatigue.
Doctors are tired. Their fatigue is spiraling out of control. They are burned out. Colleagues are leaving the profession. Retiring early. Moving on.
My associate at Mayo Clinic, Dr. Tait Shanafelt, and others looked at physician burnout in a study in the Mayo Clinic Proceedings. Over a third of US physicians reported at least one symptom of burnout: emotional exhaustion.
This type of decision fatigue doesn’t affect just healthcare providers. One study found that judges in court were more likely to grant lighter sentences or pardons earlier in the day or after a food break. So if you find yourself being arraigned, try for a morning slot before the judge just burns out and gives up.
Same with your doctor. They have to consider hundreds of data points in examining a patient. Each consumes brain power and bandwidth.
Multitasking has been endemic in medicine, but it simply does not work and flies in the face of neurobiology. We cannot do two things at once. Studies show that when we attempt to do two things at once, it takes 50% longer to complete the task, there are 50% more errors, and there is a 40% decrease in retention rate.
It is almost impossible for that provider to have a blistering focus on you, the patient in front of them, and not be distracted by thoughts and concerns of other patients and other personal issues. This is called residual attention, which carries over from a previous task.
Insider tip: Try to schedule your appointments earlier in the day. And an earlier appointment has less risk for the doctor to be getting behind. Sometimes the first appointment after lunch is ideal. Ask the scheduler for these time slots when you are making your appointment.
How can you talk so your doctor will listen?
Okay, this is not brain surgery unless you are seeing a neurosurgeon, so what do we as empowered patients have to do to live in this reality?
- Bring a list: Be crystal clear going into your exam about the reasons for the visit. Hit the big two issues or concerns right up front. This is not the time to drift into details about your daughter’s wedding, the new job, or how cute the new grandbaby is. Even email the doctor a day ahead with your list. And bring your list. Start your conversation there. This is your time.
- Summarize your concerns: Studies show that doctors interrupt patients before they can tell the doctor about their concerns. Within 18 seconds, in fact. And that same study among doctors and patients in The Netherlands found that male doctors interrupted more than female doctors. Another study among US patients, said interruptions occur within 11 seconds. It’s okay to say, “Hang on, Doc, I have just a few more points.”
- Let the doctor read your electronic record: Recognize that the physician who is reviewing your records on the screen while you are sitting there cannot be attentive to the medical record and listen to you talking. Allow the doctor to review the record before you speak.
- Bring a friend to take notes: Within reason, bring someone with you to the medical encounter who can act as your surrogate, a translator in interpreting the physician’s message to you later. To take notes. Not talk.
- Know your medications: Bring a list of the dose, schedule, why you are taking the medicine and who prescribed it. Put this on the discussion list.
- Get on your patient portal: Ask the doctor’s office for the code to access your patient portal. Know how to sign on. Ask someone in the doctor’s office for a tour of the portal (in person or on the phone). Use the portal to review your lab results and doctor notes. To message your doctor or the doctor’s nurses for prescription refills and nonurgent questions. Sometimes the portal can be quite efficient.
- Work with mid-level staff: If your doctor’s office has nurse practitioners, physician assistants, and other providers, be assured their advice will be given in consultation with your doctor. So your minor sinus infection or pesky cough might be something handled by a staff member just as efficiently.
- How long is too long? If you find yourself sitting too long in the waiting room and again in the exam room, it’s perfectly fine to go to the reception desk and reschedule. But the best strategy is to ask when you check in, “Is the doctor running on time?” If you hear something like, “She’s running behind,” or “He had an emergency, but we’ll get to you,” then consider rescheduling because you’ll get a bum’s rush when it’s your turn, just to make up for something you don’t have control over.
Waiting Time Strategies
One study found that the average wait time in the waiting room was 13.8 minutes and an additional 12.4 in the exam room. If you’ve read all the old magazines and are still waiting, go out into the hallway, go to the desk (maybe dress first), and inquire. Or reschedule.
Bottom line
No one has a greater stake in your health and well-being than you. Spend your time with your provider productively. And don’t let that doctor or that healthcare provider leave the room until your questions are answered.
If you need more time, get on the patient portal and email the doctor, who may or may not respond and may or may not charge you for that time. Better yet, make another appointment before you leave the office.
Why isn’t your doctor listening to you? Let’s blame the impersonal medical record, distracted, rushed, and overly taxed doctors, pressure to see more patients, and an unforgiving system. Now you know. And now you know what to do.