How hard is it for doctors to listen and to care?

Despite the clearly harmful impact of the time crunch, most doctors and institutions are not pushing for structural change. Instead, they are attempting to teach medical school students how to deal with the constraints the system imposes.

Sorrentino emphasized his belief that “there is no question that physicians can work within constraints and do extremely well, and have wonderful relationships in the 10-minute encounter they have to work with. We need to teach students to imitate those doctors.” But he added a caveat: “Personally, I feel that physicians are too rushed. If they had more time to sit and talk with the patient, I think we’d see higher patient satisfaction and possibly better outcomes.”

Why weren’t these issues confronted sooner?

The failure to test communications skills until recently is widely agreed to have contributed to the slow pace of change in the medical profession.

It is also true, doctors said, that communication is not as easily assessed as other elements of  medical knowledge.

“How do you put a number on compassion?” Osterberg asked rhetorically. “It really is a softer science.”

The AMA also noted that medical schools tend to have difficulty figuring out how to assess students’ communication skills, stating in a 2007 report, “While schools are using a variety of teaching and assessment methods, there is an apparent lack of structure to these activities.”

Moreover, there is little support or funding available for established physicians who were not taught communication in medical school and want to improve their skills.

According to Chou, “For those doctors who graduated 25 or more years ago, there’s really no continuing education in something like communication. Some specialties have some sort of ‘reboarding’ process, but those are largely medical knowledge-based exams, and don’t take communication skills into account.”

“There’s no impetus to change; people feel like they have [communication] skills already, and if they figure out that they don’t, it’s training that’s generally not financially supported and less valued than other, easier ways to help the patient, like prescribing medication,” Chou added.

Finally, much of medical culture continues to value scientific knowledge over effective communication; not everyone agrees with putting time and resources into improving the communication skills of doctors of all ages.

“Most people think that it’s just talking, that anybody can talk,” Arnold noted. “But this is a kind of talking that most of us don’t do.”

An ongoing challenge

Despite efforts to teach doctors how to communicate and a growing understanding that communication is an important piece of medical knowledge, progress in this area remains slow and some difficulties are not easily dealt with.

Reflecting on whether doctors themselves believe that patients are entitled to good communication with their doctors, Osterberg said that they do.

“I believe there is a sense from the medical community that patients deserve effective communication and compassion from their doctor. There are just lots of barriers: time, productivity pressures, interruptions.”

The systemic obstacles are most apparent in the time crunch, but also are reflected in the impact they have on physicians themselves, including fatigue, stress, and burnout, Osterberg said.