Length of patient's monologue, rate of completion, and relation to other components of the clinical encounter: observational intervention st
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《英国医生杂志》
1 Clalit Health Services and Department of Family Medicine, B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel, 2 Department of Community Health and Epidemiology, B Rappaport Faculty of Medicine
Correspondence to: S Reis, Departments of Medical Education and Family Medicine, B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 9649, Bat-Galim, 31096 Haifa, Israel reis@tx.technion.ac.il
Introduction
Allowing patients to complete their monologue requires little time and does not disrupt the other components of the clinical encounter. In consultations with a new clinical problem (that is, those aiming to reach a diagnosis), the number of completed monologues doubled when doctors were told not to interrupt.
The difference in monologue length between day 1 and day 2 is better represented by the median (15 and 21 seconds respectively) than by the mean (26 and 28), because the mean is affected by a number of relatively lengthy monologues. A similar difference was reported by Marvel.2
Different languages and cultures seem to have no effect on average length of monologue (Slovenia, 28 seconds3; United States, 23 seconds;2 Israel 27 seconds). Lengthier monologues have been reported in specialist settings (Switzerland, 90 seconds5).
The significant increase in the proportion of completed monologues is compatible with the observation that completed monologues are just marginally longer than interrupted ones.2 This is probably due to the natural brevity of patients' monologues.
Contributors: RL and IR wrote the protocol, collected and analysed data. AT gave statistical advice and supervised the analysis. IR wrote the first draft of the paper. All authors contributed revisions of drafts of the paper. SR supervised the whole process, wrote the final draft, and will act as guarantor.
Funding: No external funding.
Competing interests: None declared.
Ethical approval: Helsinki Committee (IRB) of the Emek Medical Center, Afoula, Israel.
References
Frankel M. The effect of physician behavior on collection of data. Ann Intern Med 1984;101: 692-6.
Marvel MK. Soliciting the patient's agenda: have we improved? JAMA 1999;281: 283-7.
Svab I. The time used by the patient when he/she talks without interruptions. Aten Primaria 1993;11: 175-7.
Blau JN. Time to let the patient speak. BMJ 1989;298: 39.
Langewitz W. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ 2002;325: 682-3.(Israel Rabinowitz, family)
Correspondence to: S Reis, Departments of Medical Education and Family Medicine, B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, POB 9649, Bat-Galim, 31096 Haifa, Israel reis@tx.technion.ac.il
Introduction
Allowing patients to complete their monologue requires little time and does not disrupt the other components of the clinical encounter. In consultations with a new clinical problem (that is, those aiming to reach a diagnosis), the number of completed monologues doubled when doctors were told not to interrupt.
The difference in monologue length between day 1 and day 2 is better represented by the median (15 and 21 seconds respectively) than by the mean (26 and 28), because the mean is affected by a number of relatively lengthy monologues. A similar difference was reported by Marvel.2
Different languages and cultures seem to have no effect on average length of monologue (Slovenia, 28 seconds3; United States, 23 seconds;2 Israel 27 seconds). Lengthier monologues have been reported in specialist settings (Switzerland, 90 seconds5).
The significant increase in the proportion of completed monologues is compatible with the observation that completed monologues are just marginally longer than interrupted ones.2 This is probably due to the natural brevity of patients' monologues.
Contributors: RL and IR wrote the protocol, collected and analysed data. AT gave statistical advice and supervised the analysis. IR wrote the first draft of the paper. All authors contributed revisions of drafts of the paper. SR supervised the whole process, wrote the final draft, and will act as guarantor.
Funding: No external funding.
Competing interests: None declared.
Ethical approval: Helsinki Committee (IRB) of the Emek Medical Center, Afoula, Israel.
References
Frankel M. The effect of physician behavior on collection of data. Ann Intern Med 1984;101: 692-6.
Marvel MK. Soliciting the patient's agenda: have we improved? JAMA 1999;281: 283-7.
Svab I. The time used by the patient when he/she talks without interruptions. Aten Primaria 1993;11: 175-7.
Blau JN. Time to let the patient speak. BMJ 1989;298: 39.
Langewitz W. Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ 2002;325: 682-3.(Israel Rabinowitz, family)