Appendix 57 - Time is Money

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

When doctors talk to patients it is more like grilling than dialogue. In one study, 74 outpatient office visits were taped. The encounters typically began with the physician soliciting a "chief complaint," asking questions like, "What seems to be the matter?" The researchers wanted to know how soon after the patient began to speak would the physicians interrupt them. The results indicate that interruption occurred, on average, 18 seconds after the patients opened their mouths.[664]

This type of treatment is understandably disillusioning for many students. Students' experiences recorded in a medical sociology text:

'They hardly talked to the patient at all. Like this was a big checkup after waiting three months or six months and then the doctor whips in for two minutes to take a quick look and then they're gone. We would get in there and he'd hold the speculum and we'd all take a look and we would just herd right out again into another room and have a look and herd out again. I thought the dehumanization was awful.'

[Another student:] 'I saw the way they were just herding in ladies that had hysterectomies and cancer, and just the way the doctors would walk right in and wouldn't even introduce us as students, and just open them up and just look and say a lot of heavy jargon. And the ladies would be saying, "How is it?" "Am I better, or worse?" And they say in this phony reassuring tone, "Yes, you're fine," and take you into the hallway and say how bad the person was....'

In trying to cope with the situation, the students began to rationalize that the large number of patients seen by the physicians precluded them from doing anything more than attending to the patient's medical condition.[665]




[664] Beckman, HB and RTM Frankel. "The Effect of Physician Behavior on the Collection of Data." Annals of Internal Medicine 101(1984):692-696.

[665] Medical Sociology:159.



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