I recently saw a prominent physician for a medical problem. She was highly regarded in her field, and it took a while to get an appointment. I really wanted to hear her opinion of my illness.
At my appointed time, I was led to an exam room, and shortly thereafter, she entered, introduced herself and promptly sat before a computer screen. While staring constantly at the screen, she went rapidly through a series of questions, which constituted her superficial effort to take a history of my illness.
We talked for about 5 minutes. And I noticed that -- during this entire time -- she never made eye contact with me. I really tried to engage her in the particular details of my complaints, but I didn't succeed.
After she had finished filling out the fields on the computer screen, she told me that she was ordering some tests. I told her that I already had had many of them. So she suggested a few that I had not had.
After about the 10th minute or so, I sensed that the appointment was drawing to a close, even though she had not actually asked me many relevant questions about my illness. After decades of practice, I am really good at presenting a medical history, but this time, I never got much of a chance to do so.
I felt I was running out of time, so I pressed her for an opinion.
"What do you think is going on?" Her eyes remained transfixed on the screen. She said she didn't know, but would run some tests.
I asked: "Are you going to examine me?" As she continued to hammer at the computer keyboard, she responded: No need to do that.
Her answer to my final questions: We'll see when the tests come back.
After the 13th minute, she finally looked at me again -- to say goodbye. Total eye contact during the entire medical appointment was less than 60 seconds.
A lot transpired during those 60 seconds of eye contact. She looked in my direction, but she was actually looking past me. In contrast, I made sure to look into her eyes, and was saddened by what I saw. There was no emotion, no connection, no empathy. She was going through the motions, and doing it as fast as she possibly could.
Most important of all (to her), she documented that she did everything right.
As she was about to leave, I put out my hand to thank her, but she didn't seem comfortable shaking my hand in return. She quickly left the room.
I was told to return to the front desk, and I made my way there slowly, remembering a time when physicians routinely made eye contact with patients during the entire medical visit.
In the past, the best part of being a physician was walking into a room, greeting a new patient along with a family member, pulling up a stool, and engaging in an opportunity to listen to a story and solve a problem. Every patient's story was totally unique, and I relished the nuances of each tale. Sometimes the expression in a patient's eyes revealed more than what they actually said.
But regardless, the ongoing eye contact with someone who trusted you was exhilarating. And not just for me. After most visits, I am certain I helped the patient more by listening, talking, and making eye contact with them than from any prescriptions I would write.
Those days have vanished for many practices. Many physicians are pressed to maintain a very tight schedule. Often, the time it takes to document a visit is longer than the actual time that is spent with a patient. Physicians are not paid for the documentation, so it is most efficient to merge the patient interaction and the documentation into the same time period. The result: documentation wins, and the patient loses.
Some physicians solve this problem by hiring a "scribe." A scribe can be another healthcare professional or simply a recorder of conversations. But good scribes are hard to find, and they need to be paid. Many healthcare systems have concluded that physicians should perform the functions of a scribe. It is very cost-effective, but it is horrifically dehumanizing. And it ensures that physicians are not spending most of their time practicing their skills.
With my medical visit complete, I arrived at the front desk, and the receptionist asked me about my follow-up appointment. "When will the doctor see you again?"
It was a curious question, and it made me think about my interactions during the appointment. And I kept wondering.
When did she see me the first time?
Disclosures
Packer recently consulted for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Novo Nordisk, Relypsa, Sanofi, Takeda, and ZS Pharma. He chairs the EMPEROR Executive Committee for trials of empagliflozin for the treatment of heart failure. He was previously the co-PI of the PARADIGM-HF trial and serves on the Steering Committee of the PARAGON-HF trial, but has no financial relationship with Novartis.