“We want to spend time with our patients,” the speaker said.
The audience nodded, and sighed.
I was a researcher at a conference for physicians, medical educators, researchers, and public health professionals. Among all the cutting-edge research, amidst all the promising practices, this one statement stood out.
“We want to spend time with our patients. To directly care for them,” she continued.
For a moment, the room was quiet. Her words seemed to stop the train of stimulus and activity that is a conference. I saw ripples of reaction through the audience. It looked like the touching of a nerve.
Time constraints have a long history
Ten years ago, a highly cited study averaged 392 routine primary care office visits, and found they lasted 15.7 minutes. (Primary care visits currently account for just over half (53.2%) of Americans’ physician office visits.)
The 15-minute visit is nothing new, and both patients and providers are generally unhappy with it. This much-maligned 15 minute ‘rule’ has been traced back 25 years to Medicare’s implementation of the RVUs. Other providers aren’t so lucky, and are seeing patients in 11 minutes, 8 minutes, or as one told me, 6 minutes.
Caring and communicating within constraints
Time is perhaps the ultimate constraint on health communication. But it’s hardly the only one. Over the last few years I’ve learned about some of the constraints you as physicians, and other health care providers, face on a daily basis, such as:
- The regulatory, reimbursement, and cost-containment environments. The punishments and rewards attached to these environments.
- Political forces that can help maintain status quo in terms of what gets talked about, written about, or funded. And what doesn’t.
- Physicians, and providers in general, being treated as the problem in healthcare—and, paradoxically, the solution.
- Social pressure from within the profession against out-of-the-norm ways of connecting with patients.
- Provider burnout.
I am grateful to the many providers who have spoken frankly with me about these and other issues, issues they have told me are sometimes are wrapped in silence. Of course I can only see these as someone who is not a provider, but a lifelong educator and a researcher.
It was powerful for me to witness the audience reaction to the speaker’s words, that day at the conference. Since then, I have been thinking about the tensions between her words, and the constraints that are part of your everyday practice. I have been thinking of this tension in terms of communication, education, and research.
Communication that works twice as hard
Understandably, much attention is spent on constraints—often about managing or negotiating them. But any communication advice that does not take these constraints into serious consideration is misguided.
It would be setting a low bar to give communication advice that implies you should ‘just deal with it.’
Or to give advice that doesn’t keep an eye on the larger picture.
Or to otherwise treat you as passive recipients of the fallout from decisions made elsewhere.
In public education, adult education, and development, studying constraints is part of the job. So is learning to work within them. There are always questions of time, money, access, language, and more.
However, some research traditions within these fields take equally seriously the responsibility of interrogating and challenging these constraints.
This means acknowledging the status quo, but also questioning it. I’m fortunate to have studied with some leaders in these transformative efforts–Vivian Gadsden, Susan Lytle, Brian Street. I have learned from them how to keep the global and the local in the eye, in research and practice.
I want to be careful not to oversimplify a very complicated set of problems. But it is possible for health communication resources to support providers in the immediate needs of your day to day practice, and also to help you look upstream, at larger issues to which your practice is connected. Including constraints. (I’m presenting on this topic at an upcoming conference. I’ll let you know how it goes.)
This, I believe, includes communication that makes the most of the time you have with a patient. That acknowledges time constraints, while questioning them.
Such work will take some collaboration, and different kinds of expertise. But I expect the same is true when dealing with any complex problem in the world. Academic silos are real, but can be overcome. That is part of what I seek to do here, and I invite you to contribute from wherever you are.
Two things you can do in the next week to begin to make a difference
When we’re surrounded by constraints, it is easy to focus on them. It is possible to be overwhelmed by the enormity of various contextual factors—time, money, access, language, and more. Yet one way to shift such a focus is to look both ways.
That is, we look not just at constraints but at resources. This includes our individual resources, as people and professionals. It includes our collective resources, as members of many communities.
Here are two ways you can focus on resources, with your next patient.
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Consider your resources
Consider how you’re currently using your personal resources.
You also have professional and community resources. And in dealing with organizational constraints, there is no doubt that communities of practice are essential. No one knows these constraints better than you and your colleagues. Finding like-minded others, in person or in social media, is more than just a feel-good move (although it can be that too).
One of your greatest resources for professional learning is in the room with you. Your patients. Consider asking yourself how you are making use of this ‘resource’:
Example Question #1: How can I learn from my patients and their families?
Asking such a question can open up new possibilities for your own development as a professional.
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Consider your patients’ resources
As I’ve encouraged you to think about your own resources, also think about your patient’s resources. It is deceptively easy to focus on patients’ problems and deficits, and overlook their strengths and assets.
To this end, ask one, new question of your next patient that will help you get to know them as a person.
Let it be a question you haven’t asked before. A question you don’t already know the answer to. Here’s some inspiration:
Example Question #2: What is one thing you wish I you knew about you, that I probably don’t know?
Asking this question can invite a new connection with your patients, and allow you to see them and their personal and community resources in a new light.
Join in the conversation
This is an invitation to join the conversation—to share how you understand and take up some of the issues raised here. I’m inviting you to contribute by writing me directly (there’s a form at the bottom of the page). Or become a free member of the site and share your story with other members in the comments.
If you are interested in taking your language use seriously, why not start with your metaphors? This workshop shows you how to break down the metaphors you use, understand their cognitive and affective aspects, and evaluate them in use. On demand, right on this site.
