| Today’s letter |
| Say this in the first six seconds of your appointment |
| The fifteen minute doctor’s appointment was not decided by a doctor. It came out of a payment formula. In 1992, Medicare started paying physicians using something called a relative value unit, a number assigned to every service in medicine. A standard office visit was worth about 1.3 of those units. Under the coding guidelines of the time, that worked out to about fifteen minutes. |
| Private insurance followed Medicare, the way it usually does, and within a few years the fifteen minute slot was simply how American medicine got scheduled. Nobody voted on it. Health reporters at KFF have written that no one knows for certain why fifteen minutes stuck. Many experts trace it straight back to that 1992 formula. So the length of your appointment was set by an accounting decision, and you have been blaming yourself for not fitting inside it. |
| “Why can’t I explain myself in there?” |
| A reader wrote to me in the spring about her last appointment. I’ll call her Diane. Eleven months of symptoms had gone into her notebook: the dizziness, the dates, the afternoons it got worse. She ran a payroll department for 22 years and never once missed a filing deadline. Organizing information is the thing she is good at. |
| She got about ten seconds in before the questions started coming at her, and none of them were about the notebook. Then the visit was over. Driving home, she decided she had rambled, so she promised herself she would be more organized next time… which is the promise almost every woman I hear from has made at least once. |
| Here’s what gets me. |
| None of it was her fault. She was not bad at explaining herself. Nobody let her finish. |
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| Let me show you how I know this. Not from my opinion, but from a study that put a stopwatch on what happens in those rooms. |
| A team led by Dr. Naykky Singh Ospina, working with colleagues at the Mayo Clinic, went back through 112 recorded medical visits from clinics in Minnesota and Wisconsin. These were video and audio recordings, so nobody had to remember anything afterward. Two reviewers watched each visit separately and timed it with software. |
| They were looking for two things. First, whether the doctor asked the patient what she had come in for. Second, if the patient started to answer, how long she got before someone cut in. The stopwatch ran from the patient’s first word to the first interruption. |
| What they found |
| Mayo Clinic and University of Florida, 2019. Singh Ospina et al., Journal of General Internal Medicine. |
| Cut off (11 seconds) |
| Doctors asked what the patient had come in for in only 40 of the 112 visits. In 27 of those 40, the patient was interrupted, at a median of 11 seconds. |
| Left to finish (6 seconds) |
| When nobody cut in, patients said what they came for in a median of six seconds and then stopped on their own. |
| Six seconds was all anyone needed. Two out of three never got to use them. |
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| In other words, the patients in that study were not long winded. Six seconds is one breath. The problem was never the length of what they had to say. |
| Diane’s ability to explain herself had nothing to do with it. Neither does yours. |
| So why would a trained doctor cut off a patient after 11 seconds? |
| The doctor is not being rude. She has a slot that was sized in 1992, a screen that wants a diagnosis code before she can go on, and a waiting room filling up behind you. Interrupting is how a chart gets finished on time. Most of those interruptions in the study were closed ended questions, which is a doctor jumping ahead to the answer she has to type. Every one of those questions is reasonable on its own… and together they mean the patient never finishes her sentence. |
| Diane never stood a chance in that room. Neither did you, I’d bet. |
| That’s the part no one says out loud. You were not failing to communicate. The room was built for speed, and it has run that way since 1992. |
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| Try this today |
| Before your next appointment, write three things on one sheet of paper, most important first. Then, the moment the doctor walks in, say the first one out loud as a single sentence, before the hello and before anyone asks you. Something like: I have been dizzy every afternoon since March, and it scares me. Say it at home once tonight and time yourself. It takes about six seconds. Hand the paper over right after, so the other two are in the room even if you never get to say them. |
| Six seconds is the whole trick. That’s all anyone in the study needed. |
| Promise me you’ll try it today? Saying it out loud is half of what makes it stick. |
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| This is not magic, and it will not fix a system that pays by the visit. What it does is put your biggest concern into the room before the interruption arrives, which may not change the appointment but gives you better odds than waiting to be asked. |
| Diane tried it in July. She led with the dizziness, handed over her page, and came out with a next step written down for the first time. One sheet of paper, after eleven months of notebooks. |
| There’s still time for you. Your next appointment is probably already on the calendar, and the paper takes two minutes tonight. |
| So write the three things down, say the first one first, and remember this on the drive home… |
| It was never your fault. |
| — Cole |
| P.S. How long did your last doctor’s appointment actually last? Just the number of minutes, hit reply. I’ll tell you tomorrow how that compares. |
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