Study Says Chatty Doctors Forget Patients

A new patient comes into a doctors office weighing 204 pounds. Hes six feet tall. The following conversation ensues:

Doctor: Is that up a little bit for you, weightwise?

Patient: It might be up a few pounds. I used to jog and I just havent ...

Doctor: See, cause Im weighing more like 172, 173 and Im six foot. And Im still running. Im doing the 5 and 10 and 15 Ks. The half marathons and ...

Patient: So, Im 30 pounds heavier than you?

Doctor: Right now, yeah.

That, a group of researchers say, is part of an actual conversation they recorded in the course of a study that showed that many doctors waste patients time and lose their focus in office visits by interjecting irrelevant information about themselves.

Their paper, published yesterday in The Archives of Internal Medicine, involved 100 primary-care doctors in the Rochester area. As part of a study on patient care and outcomes, the doctors agreed to allow two people trained to act as patients come to their offices sometime over the course of a year. The test patients would surreptitiously make an audio recording of the encounter. The investigators analyzed recordings of 113 of those office visits, excluding situations when the doctors figured out that the patient was fake.

To their surprise, the researchers discovered that doctors talked about themselves in a third of the audio recordings and that there was no evidence that any of the doctors disclosures about themselves helped patients or established rapport.

Nor, in the vast majority of cases, did the doctors circle back to the personal conversation or try to build upon it.

I think all of us on the team thought self-disclosure is a potentially positive aspect to building a doctor-patient relationship and that we ourselves were quite good at it, said Susan H. McDaniel, a psychologist who is associate chairwoman of the department of family medicine at the University of Rochester and lead author of the study.

We were quite shocked, Dr. McDaniel added. We realized that maybe not 100 percent of the time, but most of the time self-disclosure had more to do with us than with the patients.

Dr. Howard B. Beckman, medical director of the Rochester Individual Practice Association and an internist and geriatrician who was an author of the study, analyzed conversations before and after the doctors started talking about themselves.

Id been saying for many years that disclosure was a form of patient support, Dr. Beckman said. If someone says, I have a problem, and you say, I understand because I have it, too, that would be comforting. But, he added, in truth that never happens.

Patients were not comforted, he said, and conversations got off track. Four out of five times when a doctor interjected personal information, the doctor never returned to the topic under discussion before the interruption.

We found that the longer the disclosures went on, the less functional they were, Dr. Beckman said. Then the patient ends up having to take care of the doctor and then the question is who should be paying whom.

The researchers studied the conversations looking for any hint that patients were helped when the doctors talked about themselves.

We looked for any statement of comfort, any statement of appreciation, any deepening of the conversation, Dr. Beckman said.

They found none.

Dr. Jeffrey Borkan, who is a professor and chairman of the department of family medicine at Brown University, said it was easy to see why doctors thought it was helpful to talk about themselves. Doctors are told that they must make a connection with patients. But, Dr. Borkan said, the instruction is often imprecise — how do you make a connection? Many think the way to do it is by talking about themselves.

Whats shocking about this article is how often they moved from the patients concerns to their own, Dr. Borkan said.

But Dr. Richard Frankel, a professor of medicine and geriatrics at Indiana University, hopes that doctors do not conclude that the best course is to clam up completely about themselves.

Patients, for example, may ask a female physician who is pregnant when she is due or whether she is having a boy or a girl. It would not be appropriate not to say anything, Dr. Frankel said.

The Rochester researchers, though, say their results opened their eyes to their own transgressions and made them change their ways.

They also made them see that they, too, had been the victims of doctors time-wasting disclosures.

Dr. McDaniel said, I went to my doctor recently, and I realized after I left, when I was in the parking lot, that I had only asked one of my two questions because my doctor was telling me about his trip to Italy.

But not all doctors informed of the results saw themselves in the data.

Dr. John K. Min, an internist at the Kernodle Clinic in Burlington, N.C., said he had always been circumspect when he talked to patients.

Then, however, he recalled a patient who came to see him five years ago for a physical exam. Dr. Min is avid about building furniture and the patient was skilled at furniture building. The patient spent 40 minutes with Dr. Min. When he left, Dr. Min looked at his notes.

I realized that I didnt even examine him, Dr. Min said. The man, he added, was gracious when Dr. Min called to apologize.

He said, Well just wait for next time, Dr. Min recalled.

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