asks what, from the patient's point of view, would you say is a doctor's most important organ or bodily function? Come on, now. This is a serious question.
A transcript of his remarks follows:
Let's set aside patient anatomy for a moment and address the topic of physician physiology. What, from the patient's point of view, would you say is a doctor's most important organ or bodily function? Come on, now. This is a serious question. My guess is that most professional healers would say their brains rank among patient priorities. That makes sense. After all, doctors spend roughly one-third of their lives preparing the cerebral cortex for a career in medicine. I can see why. Just the complexities of making accurate diagnoses in difficult cases, for example, can require the most acute memory recall and deductive prowess.
On the other hand, surgeons might say hand-eye coordination represents their most valuable physical asset. And they could make a good case. But here's the rub: In scientific studies and from anecdotal evidence, patients don't seem to pay much mind to healthcare providers' brains or hands. Evidently, they get ample reassurance in these realms merely from providers' academic and regulatory credentials. A framed state license and diploma on the wall suffices.
Instead, patients generally say non-clinical skills are usually the deal maker or breaker in their choices of providers. One landmark study suggested that 85 percent of the time, patients change or consider changing doctors due to poor communications.1 That figure is within a few percentage points of the findings of my own firm in studies of patient complaints about their care in social media and on rate-your-doctor websites.2 Therefore, I'd like to propose this rather radical theory: If you asked patients to rank order of importance of doctors' own anatomical components in their care, they could quite conceivably say – hold on to your hats – the eyes and that part of the body containing the gluteus maximus muscles. Yes, you heard me correctly: the butt. To repeat: the doctor's eyes and butt.
Wait a minute now. I'm not referring to patients' inappropriately lascivious impulses toward healthcare providers. Rather, the critical point here zeroes in on their perception of the provider's use of those body parts. For this we turn to a few peer-reviewed scientific studies. From the old-news department, studies of patient satisfaction have repeatedly documented the importance of eye contact in physician-patient encounters. For instance, a Northwestern University Feinberg School of Medicine study investigated 110 first-time appointments with patients presenting with cold symptoms.3 With the help of videotape, the study tracked the percentage of time the providers made eye contact with the patients, and then compared it against levels of patient satisfaction, based on post-encounter questionnaires.
The investigators charted the results to what they called a CARE score. As you can see in this graph, increases in eye contact directly correlated to increases in patients' assessments of their doctors' likeability and empathy. No front-page news here, folks. But it does make the case that if you want to improve your online reviews by patients, you might start with a touch more meeting of the eyeballs.
However, you have to dive a little deeper to find the big news maker. The Northwestern study found that the effect of eye contact decreased with longer appointments. In other words, shorter physician-patient encounters demand more eye contact. But in today's harried and highly regulated clinical environment, how can doctors pull that off? In a Stanford University poll published just weeks ago, primary care physicians said that 62 percent of the time they devoted to patients was spent interacting with electronic health record systems4 – one more reason to curse the rise of computer tablets in exam rooms. To be sure, EHR devices only hinder eye contact. But man oh man, do I have a little trick for you. Here is where we come back to doctors' butts.
From the University of Kansas comes research that when physicians sit rather than stand during patient consults, patients' perception of time spent with the doc shifts profoundly.5 Specifically, on average, doctors who stood during patient encounters in the study stayed for 1 minute and 28 seconds; however, their patients estimated the docs had been there for 3 minutes and 44 seconds – more than twice as long as in reality. In contrast, sitting doctors stayed an average of only 1 minute and 4 seconds. But their patients estimated that they'd lingered longer than 5 minutes. Five minutes! Do the math. Sitting allows you to spend one-third less time with patients but creates the illusion you were with them one-third longer. Bingo: improved patient satisfaction for less effort. That's what I call having the best of both worlds: working smarter not harder.
There you have it, the odd juxtaposition of body parts at opposite ends of the corpus. It's not getting easier for over-worked and over-stressed healthcare providers to keep their customers happy. Yet the easiest solution could be as simple as keeping eyes on patients and butts in chairs. Such a coupling of small changes just might make all the difference.
1. Cousins N "How patients appraise physicians" N Engl J Med 1985; 313(22):1422.
2. King R, et al "Hard internet truths: 34,748 online reviews reveal what patients really want from doctors" J Medical Practice Management; March/April 2016.
3. Montague E, et al "Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy" J Participatory Med 2013, August 14; 5:e33.
4. Stanford Medicine "Doctors call for overhaul of Electronic Health Records" June 4, 2018.
5. Swayden K, et al "Effect of sitting vs standing on perception of provider time at bedside: A pilot study" Patient Education and Counseling 2012; Vol. 86, Issue 2, 166-171.