Pierson S Ryan, Lam Ryan, Ngoue Marielle, Rajagopalan Dayal, Ring David, Ramtin Sina
From the Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX.
J Am Acad Orthop Surg. 2023 Nov 1;31(21):1129-1135. doi: 10.5435/JAAOS-D-23-00071. Epub 2023 Jul 18.
Clinicians tend to interrupt patients when they are describing their problem, which may contribute to feeling unheard or misunderstood. Using transcripts of audio and video recordings from musculoskeletal (MSK) specialty visits, we asked what factors are associated with (1) Perceived clinician empathy, including the time a patient spends describing the problem and time to the first interruption, (2) duration of patient symptom description, and (3) duration between the end of greeting and first nonactive listening interruption.
We analyzed transcripts of 194 adult patients seeking MSK specialty care with a median age (Interquartile range [IQR]) of 47 (33 to 59) years. Participants completed postvisit measures of perceived clinician empathy, symptoms of depression, accommodation of pain, and health anxiety. A nonactive listening interruption was defined as the clinician unilaterally redirecting the topic of conversation. Factors associated with patient-rated clinician empathy, patient problem description duration, and time until the first nonactive listening interruption were sought in bivariate and multivariable analyses.
The patient's narrative was interrupted at least one time in 144 visits (74%). The duration of each visit was a median of 12 minutes (IQR 9 to 16 minutes). The median time patients spent describing their symptoms was 139 seconds before the first interruption (IQR 84 to 225 seconds). The median duration between the end of the initial greeting and the first interruption was 60 seconds (IQR 30 to 103 seconds). Clinician interruption was associated with shorter duration of symptom description. Greater perceived clinician empathy was associated with greater accommodation of pain (regression coefficient [95% confidence interval] = 0.015 [0.0005-0.30]; P = 0.04).
Clinician interruption was associated with shorter symptom presentation, but not with diminished perception of clinician empathy. Although active listening and avoidance of interruption are important communication tactics, other aspects of the patient-clinician relationship may have more effect on patient experience.
临床医生在患者描述问题时往往会打断患者，这可能会导致患者感觉自己的话未被倾听或被误解。通过使用肌肉骨骼（MSK）专科就诊的音频和视频记录文本，我们研究了哪些因素与以下方面相关：（1）患者感知到的临床医生同理心，包括患者描述问题所花费的时间以及首次被打断的时间；（2）患者症状描述的时长；（3）问候结束至首次非积极倾听打断之间的时长。
我们分析了194名寻求MSK专科护理的成年患者的记录文本，这些患者的年龄中位数（四分位间距[IQR]）为47（33至59）岁。参与者完成了就诊后关于临床医生同理心、抑郁症状、疼痛适应和健康焦虑的测量。非积极倾听打断被定义为临床医生单方面改变谈话主题。在双变量和多变量分析中，寻找与患者评定的临床医生同理心、患者问题描述时长以及首次非积极倾听打断前的时间相关的因素。
在144次就诊（74%）中，患者的叙述至少被打断了一次。每次就诊的时长中位数为12分钟（IQR 9至16分钟）。患者在首次被打断前描述症状的时间中位数为139秒（IQR 84至225秒）。初始问候结束至首次打断之间的时长中位数为60秒（IQR 30至103秒）。临床医生打断与症状描述时长较短相关。更高的临床医生同理心感知与更大的疼痛适应相关（回归系数[95%置信区间]=0.015[0.0005 - 0.30]；P = 0.04）。
临床医生打断与较短的症状呈现相关，但与临床医生同理心的感知降低无关。尽管积极倾听和避免打断是重要的沟通策略，但医患关系的其他方面可能对患者体验有更大影响。
