This is one of the most common questions we hear in our Living Well with Illness workshops. There are lots of reasons why doctors don’t let patients tell their stories, from being pressed for time to being poor communicators. Individual patients may not have much influence on their doctors’ listening skills, but now more than ever, medical educators are recognizing that these skills are an essential part of good health care.

Until recently, skills for communicating with patients were not considered all that important. Prospective medical students were evaluated solely on their academic performance, not on their ability to communicate, and practices that helped doctors establish rapport with patients were often nothing more than an afterthought in the curriculum, if they were included at all.

Years ago, doctors were more authoritarian, telling patients what to do and expecting them to do it. Patients were also less likely to speak up during appointments about health-related concerns that they thought their doctor wouldn’t be interested in.

But times have changed. Patients want more say in their health care and most doctors want to include them in decision-making. Many patients, especially those with chronic illnesses, also want to tell their doctors about issues that not that long ago would have been considered outside the sphere of medicine but have a significant impact on their daily lives.

There are other reasons doctors discourage patients from talking. About half of all doctors are now employees of hospitals or large practices. And they are often required to see more patients in a day than they would like. They often have to rush through appointments so they don’t fall behind.

On top of all this, doctors have to contend with the electronic health record (EHR), which is almost universally criticized by physicians for putting more emphasis on what’s on the computer screen than on the patient’s needs. Doctors complain about less time for eye contact, physical exams, and listening to patients. EHRs have created an enormous time burden on doctors both inside and outside the exam room, contributing to widespread burnout among physicians.

The upshot is that doctors don’t like the situation any more than patients do. And the good news is that changes are happening in the way doctors are being educated.

This post is the first in a series that will summarize a recently published paper called, “Practices to Foster Physician Presence and Connection with Patients in the Clinical Encounter.”[1] After looking through the scientific evidence and speaking with medical and nonmedical professionals on effective communication, the authors of the paper came up with five recommended physician practices to help foster presence and meaningful connections with patients.

The next issue of the newsletter will address the first practice:

Prepare for the clinical encounter with intention.

We hope you will join us in exploring this topic.

[1] Zulman DM, Haverfield MC, Shaw JG, et al. Practices to foster physician presence and connection with patients in the clinical encounter. JAMA. 2020;323(1):70-81. doi:10.1001/jama.2019.19003