Over the last 50 years, the model of doctor-patient relations has gradually shifted from a doctor-consulting, authoritarian model (paternalism) to one of doctor-patient cooperation (collaboration, stewardship). Communication is essential to this relationship. In recent years, there has been an increased focus on streamlining physician communication in clinical consultations with the goal of providing patient-centered services. Often, doctors and patients will interrupt each other during visits, but what are the reasons for and effects of these interruptions?
Meaning and effect
An interruption is any act that physically disrupts the flow of conversation or impedes the further development of a conversational topic.
Distractions can have a negative impact on key aspects of communication, particularly the sharing of information with the patient or the development of a relationship with the patient. Many studies have indicated that there are many interruptions in adult outpatient visits, and up to 75% of patients are interrupted by a doctor before they finish speaking. This disruption reduced a patient’s average time to first presenting their problem from 73-150 seconds to 12-23 seconds.
Intervention or cooperation?
The impact of interruptions on clinical visits remains unclear. Some studies mainly show the intrusive effect of interruptions, especially when the doctor uses it tactically to gain control over the conversation and which can potentially cause a scenario where the patient cannot fully disclose their concerns.
An opposing view is that not all disruptions are negative, such as in scenarios where collaborative disruptions can help maintain the content and flow of the interaction. For example, physician-led collaborative interventions may facilitate coordination of patient health care and may even be supportive and collaborative with the patient.
In general, intrusive disturbancessuch as topic changes and disagreements, are seen as more negative than typical interruptions interference with cooperationsuch as explanations and contracts.
Gender and disorders
Disorders have long been associated with masculinity and masculinity, although others have questioned this direct link between gender and disorders. A systematic analysis of collaborative and intrusive interference at various consultative levels of communication in clinical practice is lacking.
One study conducted in a clinic assessed whether speaker role (physician vs. patient) and speaker gender predicted the type of interruption during these specific consultation phases (initial visit or follow-up). On average, the consultations lasted 870 seconds (14.5 minutes), ranging from 275 seconds (4.5 minutes) to 2091 seconds (35 minutes). During the analysis, the researchers focused on the presentation phase of the problem and the diagnosis or treatment plan phase, given that they are characterized by specific tasks and goals for the doctor and the patient.
Interruptions were defined as instances in which a new speaker began speaking during a silently insufficient rotation of an existing speaker, which most often involved overlapping speech.
All consultations had at least one interruption, with an average of about 29 interruptions per consultation.
Of the total 2405 interferences detected, 1994 (82.9%) were cooperative and 304 (12.6%) were intrusive. For the remaining 107 disturbances (4.4%), the type of disturbance was unclear, most often due to inaudible speech.
Patients made 55.5% of all interruptions, 55% of collaborative interruptions, and 58.9% of interruptions. Physicians made the first interruption in 56% of 84 recommendations, an average of 36.3 seconds after starting the problem presentation process, and 89% of these interruptions were collaborative.
Predictions of type
Interruptions were significantly more likely to be made in the following ways:
Of patients than doctors (odds ratio [OR] = 3.17)
More men than women (OR = 1.67)
In diagnostic or treatment planning phase than problem presentation phase (OR = 2.24)
In the medical group, men were more likely to make intrusive interruptions than women (OR = 1.54)
In the patient group, men were less likely to make intrusive interruptions than women (OR = 0.70).
While physician interruptions to patients have long been considered intrusive procedures that should be avoided, these findings show that most interruptions by physicians actually are. note intrusive. The doctors mainly interrupted the patients to express understanding and support, or to ask for clarifications, thus coordinating the patients’ ongoing narration and thus the role of the patient as the first speaker. These data support the hypothesis that physician collaboration interruptions at the start of a consultation can improve, rather than hinder, the quality of communication.
Patients interrupted doctors more often than vice versa and more often in an intrusive way. These findings correct the leading assumption that it is mainly the physician who behaves intrusively during medical communication. Moreover, male physicians and female patients were most likely to interrupt intrusively, and female physicians and male patients were most likely to interrupt cooperatively.
Physicians were less likely than patients to intrusively interrupt the other during the problem presentation phase, suggesting that physicians in this study recognized the patient’s control during this initial and critical phase.
On the other hand, in the diagnosis or treatment planning phase, doctors made almost as many interruptions as patients, indicating more tension or time pressure and repeated use of force in taking and holding the conversational floor.
In summary, physician-patient interventions are often collaborative activities that can enhance the clinical interaction and, subsequently, the physician-patient relationship. Especially at the level of problem presentation, clinicians’ interruptions to show agreement or to ask for clarification acknowledge the patient in his role as the main speaker, acknowledge the content of the patient’s story, and show engagement in communication.
This article was translated from Univadis Italy.
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