The 18-Minute Doctor's Appointment Challenge

Americans get, on average, 18 minutes with their primary care doctors at each visit. Here's how to use your time to get the care you need

By Brenda Goodman

Doctor’s appointments can be as frustrating as they are necessary, especially if arthritis is not the only reason you’re in the office. 

In fact, studies have found that the more chronic conditions you have – and most adult primary care patients have at least two – the less likely you are to be satisfied with your doctor’s care.

At least part of the reason for that is time, says Larry Mauksch, a senior lecturer on family medicine at the University of Washington in Seattle who studies doctor-patient communication. He authored a review of effective doctor-patient communication strategies in the July 14, 2008 issue of the Archives of Internal Medicine.

“The evidence suggests that the length of the visit with the physician has not decreased as much as doctors and patients think it has,” Mauksch says. “What has changed is the amount of time available for a meaningful exchange.”

Doctors today are required by the government, insurance companies and professional organizations to carefully document nearly every aspect of patient care – from how they protect your privacy in the waiting room to how often and how long they wash their hands.

“All these extra requirements come into the medical encounter and take time,” says Mauksch.

But there is a way, even with so many demands on your doctor’s time, to have your complaints heard and get your most important needs met – all within that 18-minute window.

And the best news is that even if your doctor is not gifted with a wonderful bedside manner, there are concrete things that you can do to enhance communication.

Establishing an effective dialogue has benefits that go beyond the exam room.

Several studies by researchers at the University of California at Irvine have demonstrated that good doctor-patient communication resulted in lower blood sugar levels in diabetic patients and lower blood pressure for patients with hypertension. Other studies have found that positive doctor-patient visits result in reduced pain for patients with cancer and other illnesses.

But the converse is also true: Miscommunication with you doctor isn’t just aggravating; it can be life-threatening.

“Unless we are really trained and activated,” Mauksch says, “we tend to give up a lot of power to physicians.” And studies have shown that the more equal the relationship between doctor and patient is, the more likely it will translate into health benefits. 

Here are the ways you can take charge at each stage of your visit, and communication strategies that will ensure you feel better before you even leave the office.

Before the Visit

Put pen to paper.

Make a list of all the reasons you want to see the doctor. These may include everything from unexplained aches and pains to prescription refill requests to questions you have about something you read on the Internet.

Mauksch says it’s also a good idea to prioritize the list so you can tell your doctor what’s most important to address at that visit.

Recruit a friend or relative to go.

When you’re in a chilly exam room, dressed in a paper gown, it can be difficult to focus on the time you’ll have to interact with your doctor, especially if you’re also feeling sick and miserable. That’s why it’s a good idea not to go it alone. 

A companion can help do everything from drive to take notes to ask questions. In fact, researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore found that when patients had someone to help them communicate with their doctors, they were 50 percent more likely to be satisfied with their doctor’s ability to give information and 30 percent more likely to be satisfied with their physician’s interpersonal skills.

Minute 1

Build rapport.

Why: Though they may sometimes seem impersonal and cold, doctors are of course human. Taking a few moments to connect can help them set a different tone with you.

How: If your doctor is already a skilled communicator, Mauksch says, there’s a good chance she will open the visit with a handshake or a non-medical question. For example, if she knows your son has recently left for college, she might ask, “How is it going now that your son has left home?”

If, however, the doctor breezes into the exam room staring down at your chart and seems very distracted, slow her down and bring her attention back to you by making her aware of her behavior. Mauksch says a comment like, “It seems like you’re having a very busy day,” or “you seem really frazzled,” should do the trick.

What to avoid: Overdoing it. Getting drawn into a long personal exchange can end up putting even more time pressure on the interaction, frustrating you and your doctor.

Minutes 2 to 3

Review the list of reasons for your visit.

Why: According to a study by researchers at the University of Rochester in New York, doctors listen to a patient’s concerns for an average of just 22 seconds before interrupting. That means your doctor may only hear the first one or two reasons for your visit, creating the possibility that your most urgent or bothersome complaints will go unaddressed.

However, if you list your complaints, before your doctor asks where it hurts, it helps your doctor to know what needs her focus at this visit, and it puts you in control of the flow of information. 

And going over your list really won’t take that long. A study published in the Sept. 28, 2002 issue of the British Medical Journal found that when patients are allowed to speak at the beginning of a doctor’s visit without interruption, most spent less than two minutes spelling out their complaints.

How: Tell your doctor that you’ve made a list of things you’d like to address and ask if it’s okay if you go over it with him. Explain that you'd like some help determining which problems are most important to tackle at this visit. That will let your doctor know that you respect his time and that you’re willing to accept some of the responsibility for time management.

What to avoid: Using demanding language that will put your doctor on the defensive. “You want to use words that will ‘activate’ your doctor, that will cue her into working with you in a collaborative, efficient way,” Mauksch says. Ask, don’t tell, and your doctor will most likely agree.

Minutes 3 to 5

Set an agenda.

Why: Primary care doctors are generally asked to tackle three to six patient concerns per visit, and there usually isn’t enough time to address them all. Without setting priorities, some of your most pressing needs might fall by the wayside.

“The mistake doctors make,” says Mauksch, “is that they hear one or two symptoms and they immediately go into diagnosis and treatment and when they come up for air the visit is already half over.”

When your doctor knows the number and urgency of your concerns, she will be more likely to address the problems that are most important to you and to her. She also will be better able to make rapid judgments about time constraints.

How: After reading over your list, tell your doctor about the top two or three things that are most pressing, and ask your doctor if, based on her expertise, those seem like the most critical issues that need to be addressed. “Remember that doing a good job on one problem may mean setting others aside temporarily,” Mauksch says.

What to avoid: Deviating from agreed upon priorities. If you asked to talk about your diabetes and new back pain, for example, don’t launch into a discussion about the side effects of your high blood pressure medication. Similarly, if your doctor seems to get side-tracked, gently ask why he or she feels its important for you to get vaccinations at this visit when you came to talk about back pain.

Minutes 5 to 16

Get ready for the clinical exam.

Why: Your doctor will likely use this time to investigate your symptoms, “open wide!” and discuss challenges that prevent you from managing your disease.

How: Be honest. Now is not the time, as the British say, to keep a stiff upper lip. If a hardship like the loss of a job has made it difficult to stick to a diet and exercise plan that controls your blood sugar, let your doctor know. He may be able to temporarily increase the dose of your medication to protect your health until you can get your routine back on track. Similarly, disclosing financial difficulty may prompt your physician to be mindful of the cost of treatments and tests he orders. 

Also, if something about your symptoms is scaring you, don’t be afraid to say so.  For example, if you’ve been feeling unusually tired, and you remember that your father experienced the same kind of fatigue just before he was diagnosed with cancer, let your doctor know so he can thoroughly investigate and hopefully relieve your fear.

What to avoid: Clamming up. It can certainly be intimidating to be poked and prodded, but it’s important to continue to communicate with your doctor during this diagnostic phase so he or she can make a well-informed decision about your care. This is when having a friend or family member in the room can help.

Minutes 16 to 18

Create a treatment plan.

Why: Studies show that when you, the patient, are involved in your treatment, you’ll be more satisfied and have a better health outcome. Your doctor will also be less likely to generate unnecessary tests and referrals.

How: Review your doctor’s conclusions and the course of action you decided to take after the visit. For example, if your doctor warned that your blood pressure was too high and needed to be lowered, you might say something like “I know my blood pressure is too high, but we agreed that I should try getting more physical activity, managing my stress and cutting more salt out of my diet. If my blood pressure is still too high at our next visit, we agreed that I should consider taking medication.”

This is also the time you should ask your doctor to make a note of any problems you weren’t able to discuss. Making a written record, Mauksch says, makes it more likely that you’ll get your concerns addressed by the next visit. Better yet, tell the doctor you want to repeat the instructions to make sure you understand.

What to avoid: Leaving before you really understand either your doctor’s instructions or the reasoning behind his decisions. Research shows only 15 percent of patients fully understand what their doctors tell them, and that 50 percent leave their doctor’s offices uncertain of what they need to do to take care of themselves. 

If you’ve brought a companion with you, be sure to ask that they write down your doctor’s instructions. If you’re on your own, it’s okay to bring a small recording device so that you can review your discussions later, just be sure to ask the doctor if it’s OK to record before you switch it on. If your physician uses an electronic medical record, they should be able to print an after-visit summary that details the important parts of the visit and treatment recommendations.

Taking an active role in your interactions with your doctor doesn’t just make the visit more pleasant. Studies have shown that speaking up will impact your health. Sherrie H. Kaplan, PhD, co-director of the center for health policy research at the University of California at Irvine says she believes that patient passivity, “should be treated as a risk factor for chronic disease.”

Which means the more you are able to help your doctor direct your care, the more likely it is that you’ll get where you want to go.