I’ve heard a story about a doctor who, upon entering a patient’s room, would turn to the nurse on duty and ask for a cup of coffee. The nurse would promptly leave but return quietly without the beverage, knowing that the doctor didn’t actually want his caffeine fix. The doctor simply requested coffee to signal to patients that he was ready to sit down, settle in and listen to their concerns. This was his way of saying that he was making time for the patient.
This doctor seemed to recognize how critical time is in healthcare. As one patient advocate put it, “If one wish could be granted for patients, it would be for more time with their doctor.” A desire for more time with doctors might resonate with most of us, but what you might not know is that the amount of time you think you’ve spent with a doctor can affect your healthcare quality in important ways. Patients who believe they’ve spent more time with a doctor are more satisfied with their visits and more inspired to follow the recommendations their doctor makes.
But time is a scarce resource in healthcare. The median office visit in the United States is a short 13 to 16 minutes — less than one-third the time the average person spends browsing Facebook each day. Other demands fill doctors’ schedules. One study showed that doctors spend about double the amount of time on electronic health records and desk work as they do on face-to-face interactions. Another showed that they spend as much time typing on their computer as they do looking patients in the eye. This lack of time for meeting with patients is just as frustrating to providers as it is to patients. In a recent survey of over 17,000 physicians across the U.S., only 13.9 percent said they have the time they need to provide the highest standard of care.
But there’s a catch: Not all minutes are not created equal. Patients often don’t accurately estimate how much time their doctors spend with them. In a study of 294 patients in the U.K., only 17 percent were right when they guessed how long their visit had been. Nearly 52 percent of patients underestimated the amount of time that the doctor had spent with them, and 31.3 percent of patients actually thought the doctor had spent more time with them than in reality. The same number of ticks on the clock can be experienced differently.
This is where that legendary cup of coffee comes into play. Maybe hearing the doctor request a cup of coffee at the beginning of their conversation actually made his patients feel as if he had spent more time talking with them, even if the actual number of minutes didn’t change. Can providers use strategies to change how long patients believe a visit lasts, without actually costing providers additional precious time?
My research suggests so. In a recent study, my colleagues and I carefully controlled the actual amount of time that providers spent with patients. Each provider — one of the medical or nursing students we hired to conduct the exam — administered a general checkup, which entailed measuring height, weight and blood pressure, and asking a few questions about health history. They timed their interactions with a stopwatch to make sure that each lasted precisely 10 minutes and followed a script so that every interaction was similar. Patients got the same information, and providers were trained to remain professional but neutral while talking to participants. At the end of each exam, the participant rated how warm the provider was by answering how much they agreed with statements like “The provider made me feel at ease” and “The provider was friendly when speaking with me.”
Even though all visits lasted 10 minutes, participants’ duration estimates varied widely, from as short as two minutes to as long as 30. The key was how much patients felt they connected with providers. When patients rated a provider as friendlier, they estimated longer visits. In fact, visits from providers who were rated the warmest were estimated to be about five minutes longer than those with providers rated least warm. This corresponds to at least a 30-percent increase in perceived median visit time. By connecting more with patients, my results suggest, doctors can make patients feel as if they spend more time with them.
Importantly, some of my other research shows that providers can make themselves seem warmer to patients by modifying their behavior in small ways, without lengthening visits. In one study, we trained a provider to do simple things, such as make eye contact while asking patients questions rather than stare at a computer screen. We were able to produce dramatic changes in how much patients felt they connected with the provider, even without increasing the number of minutes the provider spent with them.
Other studies offer simple strategies to change perceptions of time spent with doctors. One found that postoperative neurosurgery patients believed that doctors who sat down, rather than stood, while talking to them had spent more time with them. The actual amount of time was the same — one minute, on average — whether doctors stood or sat. But patients guessed that sitting-down conversations lasted about five minutes, as opposed to three minutes when doctors stayed on their feet. Another study found similar results in an emergency room.
All of this suggests that there may be creative solutions to the problem of lack of time in healthcare. By building a rapport with patients, doctors may be able to make their limited time go further and count more. Some strategies to connect with patients might be as simple as taking a seat, making more regular eye contact or just asking patients a question or two about their life.
It’s not just on doctors — patients could try to connect with their doctors too. The next time you step into a doctor’s office, you could ask them how their day is going, comment on the family photo displayed on their desk or thank them for taking the time to see you during what you’re sure is an extremely busy day.
Of course, changes should be made at the system level to give providers more of the valuable time that they need with patients. But by focusing on factors that shape patients’ experience of time, we can help to make the most of the limited time doctors and patients have together.