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Wednesday
Jul252018

The Sounds of Silence

By Kim Bellard, July 25, 2018

Listen closely, healthcare organizations and professionals: those sounds you are not hearing are the voices of people not speaking up, including patients. And that’s a problem.

Let’s start with the elephant in the room: a new study found that even when physicians actually asked patients why they were there, on average they only listened to the patient’s explanation for eleven — that’s 11 — seconds before interrupting them.

Think about that, and then think back to a doctor’s visit you had about something that was worrying you: could you have explained it in eleven seconds?

Believe it or not, that’s not the worst of it. Only 36% of the time did patients even get a chance to explain why they were there. Even then, two-thirds of them were interrupted before they had finished.

Primary care doctors did better, allowing 49% of patients to explain their agenda for being there, versus only 20% for specialists. Hurray for the primary care physicians…

The researchers say there are many reasons why physicians aren’t listening better, including time constraints, burnout, and lack of communications training. But still…11 seconds? For the minority that even get the chance to talk?

As Bruce Y. Lee said in Forbes, “A doctor’s visit shouldn’t feel like a Shark Tank pitch.”

As bad as this is, it is not the only area where not feeling able to speak up is a problem in healthcare. For example, a study in BMJ Quality and Safety found that 50% to 70% of family members with a loved one in the ICU were hesitant to speak about common care situations with safety implications.

It’s not just patients who are silenced. One study found that 90% of nurses don’t speak up to a physician even when they know a patient’s safety is at risk. Another survey, of medical students in their final year of school, found that 42% had experienced harassment and 84% had experienced belittlement.

A couple of years ago ProPublicalooked at why physicians stay silent about other physicians they know commit medical errors, including ones who do so repeatedly. One physician, speaking about his hospital, told them:

There’s not a culture where people care about feedback. You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you.

It’s about power: who has it, or at least who we think has it. We trust our doctors (although not as much as our nurses!). We assume that more experienced doctors have more knowledge than newer doctors, that doctors know more than nurses, and that healthcare professionals know more than we do. We’re at the bottom of the knowledge tree.

But that may not be true. Dave deBronkart — e-patient Dave — likes to cite Warner Slack’s great quote: “Patients are the most underused resource.”

But healthcare professionals must be willing to listen, and they must ensure that they ask. And we must take the initiative to speak up.

Our values are wrong if we allow reimbursement considerations to squeeze our time with physicians to the point we’re not talking and they’re not listening. Our values are wrong if we’re conditioned to think our opinions and concerns do not matter. Our values are wrong if everyone is not only empowered but also expected to speak up, especially when we see or experience something we think is a problem.

Anybody listening?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

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