Chit-chat counts more than you think to your patients

Managed care and the patient volume demands it brings sometimes make physicians feel they are trapped in a swift-moving revolving door. It's all too tempting to move patients in and out of the exam room as quickly as possible when you've got a backup in your waiting room and the day is not even half over.

As physicians, we can't surrender entirely to this temptation. Study after study has pointed out that there is a positive correlation between patient satisfaction and what I call social conversation - the casual chit-chat that precedes getting down to the business of the medical visit. And patient satisfaction is central to the way patients, as well as the managed care organizations we contract with, view our performance as physicians.

In a recent study supported by the Agency for Health Care Policy and Research, Northeastern University's Judith Hall, PhD, and her colleagues examined the relationship between the health status of patients, the physician's pattern of communication, and patients' satisfaction with the care received.

The purpose of the study was to find out why sicker patients seem to be less satisfied with their medical care than healthier patients. The occurrence of social conversation was the mediating link between health care and patient satisfaction. Patients in better health received more social conversation, which in turn influenced their higher rating of the physician's psychosocial responsiveness and their relationships.

This study enforces one of the driving factors that led many of us to choose primary care: We develop long-term and significant relationships with our patients. We must remember that the quality of those relationships affects the patient's perception of the care they receive. The long-term relationship and interacting with the patient must not be sacrificed when promoting the development of an efficient practice that will enable survival in the world of managed care.

Cutting corners on communication is an easy way to get more patients in and out of the examination room. However, this is likely to alienate our patients, causing them to be less trusting and thus less willing to take their problems to their doctor early on. Once these patients finally show up in our office, they are sicker and costlier to treat - the antithesis of preventive care and many other tenets of managed care.

Hall's study reminds me of a study often referred to in my residency, and to which I often refer when teaching. This study demonstrated that if a physician sat down and talked with his or her patient, as opposed to standing by the bed or examination table, the patient's perception was that the physician had taken more time to interact. This perception occurred even though the actual time spent with each patient was the same.

Our patients are like the rest of the population, including ourselves: They want to be heard, they want to be valued, and they want to interact. All of us know that to one degree or another there is a mind-body connection. If we can spend a little more time interacting with our patients, sick or otherwise, we will quite possibly assist in improving our patients' health status.

What does this mean in practical terms? It means we need to hone our skills to determine which patients want or need chit-chat. We cannot chit-chat with everyone.

This is actually easier than it may seem. I doubt that a 30-year-old with a sinus infection, or a 50-year-old with chest pain, desire chit-chat. They wanted to be evaluated and treated in a rapid fashion.

But the patient with chronic heart disease and diabetes probably does want to salvage something out of all the time they spend at the doctor's office, and even look at it as a social event. The patient who is terminal with a slow-growing cancer is probably having difficulty chit-chatting with anyone. If the doctor takes time to talk, there can be a significant increase in such a patient's self-esteem and feelings of self worth.

In short, we need to take time with those patients who need us to take time with them. To do this, we must develop a way to identify these patients. Our ability to communicate has a direct correlation with patient satisfaction with the care we render, not only on a medical level, but on a personal level as well. By communicating, we impart value to the interactive process. Any time we impart value, we improve the quality of care. We can never do too much of that.