One in three patients will receive the wrong diagnosis firsthand, according to the Agency for Healthcare Research and Quality (AHRQ). Research cited by the agency suggests that 79 percent of diagnostic errors are related to the patient-clinician encounter, with up to 56 percent associated with miscommunication during that encounter.
Research has also found that patients can be interrupted by physicians 11 seconds after beginning to describe their concerns.
These figures highlight a fundamental challenge in modern medicine: when healthcare becomes increasingly focused on speed, efficiency, and processing more patients, the conversations that help physicians understand those patients can be cut short.
The consequences can extend beyond a frustrating appointment to missed information, delayed diagnoses, and treatment decisions that fail to account for what matters most to the individual.
In modern healthcare, it is remarkably easy for a human being to be reduced to a number.
A patient becomes a chart, a diagnosis, an MRI result, a procedure scheduled for Thursday morning, or the next name on an increasingly crowded clinic schedule. But to the person sitting in the examination room, the issue is rarely routine.
It may determine whether that person can continue working, exercise again, sleep without pain, care for a spouse, travel, wear a normal shoe, or simply return to the life he or she once took for granted. That distinction matters.
Patient First
After more than three decades in private practice, I have become convinced that one of medicine’s greatest challenges is not simply developing better treatments. It is making sure we do not lose the individual patient while creating a healthcare system designed for greater efficiency.
Efficiency is necessary. Physicians work in an environment of packed schedules, documentation requirements, insurance restrictions, administrative demands, and increasing pressure to see more patients in less time.
Technology has also transformed medicine, often for the better. We have access to extraordinary imaging, electronic records, sophisticated diagnostic tools, and now artificial intelligence.
But medicine cannot become so efficient that listening becomes inefficient.
Two patients can walk into a physician's office with exactly the same diagnosis and need very different things.
Their anatomy may be different. Their physical condition may be different. Their occupation, age, activity level, family responsibilities, and tolerance for recovery may be different. Most importantly, their priorities may be different.
One patient may simply want relief from pain. Another may want to return to running. Someone else may need to get back to work as quickly as possible because taking six weeks away from a job is financially impossible.
Those are not secondary details. They are part of the diagnosis because they influence what a successful treatment outcome actually means.
Importance of Listening
I see this frequently in my own specialty of foot and ankle surgery. Two patients may both be diagnosed with a bunion, but that does not mean they have identical deformities or should automatically receive an identical treatment plan. Their bone structure, joint mobility, biomechanics, cartilage, severity of deformity, and personal objectives can differ considerably.
Physicians have an obligation not only to diagnose and treat, but to listen. When patients leave an office confused, rushed, or feeling as though no one truly listened to them, something larger is damaged. Trust begins to erode. And once patients lose confidence that the healthcare system sees them as individuals, rebuilding that trust can be difficult.
The connection between listening and diagnostic safety is well documented. The AHRQ's patient engagement toolkit encourages patients to share their full health story and clinicians to listen without interruption at the beginning of an appointment. The agency identifies communication and information-sharing between patients and clinicians as important opportunities to improve diagnostic safety.
Research published in the Journal of General Internal Medicine also examined interruptions during primary care appointments. In observations of 60 routine visits, patients spoke uninterrupted for an average of 12 seconds, and physicians interrupted patients before they finished speaking in approximately one-quarter of visits. The study illustrates how easily a patient's account can be cut short, even in an ordinary consultation.
A patient may be one appointment in a doctor's day.
But to that patient, the reason for that appointment may be affecting every part of his or her life.
That is why every patient matters.
Dr. Richard Moy is a Southern California foot and ankle surgeon who developed his approach to virtually painless bunion correction in 1992. All views expressed are the author's own.