"Anything Else?"

"Listening, not imitation, may be the sincerest form of flattery."
- Dr. Joyce Brothers

How long do you get to talk before your physician interrupts? An interesting study looking at communication between physicians and patients [Marvel MK, JAMA 1999; 281(3): 283-87] demonstrated that doctors take control of interviews far too early and often do not let patients ask all of their questions. The physicians studied interrupted their patients after a mean of only 23 seconds! In 25% of the visits, the physician never asked about the patient’s concerns at all. Only 28% of patients were able to get through their list of questions.

This study came to mind recently while seeing patients in a busy clinic. When I noticed one of the names on the schedule, I groaned. The man is a healthy cancer survivor whose appointments never go well. Physically, he is doing very well. As I was wrapping up, though, he launched into a long, slow litany of questions. A fifteen-minute visit stretched toward forty-five. Mercifully, someone noticed the growing stack of charts and arrived to bail me out. I was badly delayed and he felt that his time had been cut short. Neither of us was satisfied and I realized that we would repeat this scenario again in a few months.

So, what did Dr. Marvel’s study recommend? Whenever possible, physicians were encouraged to listen carefully, focus on the patient’s agenda, and use open-ended solicitations. In the clinic, the most effective strategy included the repeated use of the phrase, "Anything else?" Surprisingly, the office visits were no longer with this approach. The quality of the interaction improved.

I quietly slipped out and moved to the next exam room. I shuddered as I considered the effect of asking my patient "Anything else?" But we’ll see.

Bruce H. Campbell, MD, FACS
Interim Director
Froedtert & Medical College Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.