| Today’s letter |
| The one sentence that gets your doctor to hear you |
| A reader named Diane wrote to me last week about an appointment she had in June. She had been getting up three or four times a night to use the bathroom, and it was wearing her down. The night before, she sat at her kitchen table and typed the whole thing into one of those AI chatbots, the way a lot of people do now. Then she wrote three questions on the back of an envelope, in pen, so she would not forget them. Doctors are seeing a lot of this lately: a survey of providers this spring found that nearly four in ten of them now have patients showing up with a chatbot summary in hand. |
| Diane got through about half of the first question. Her doctor was already typing, and he was already asking about her blood pressure medication, which was not one of the three things on the envelope. The envelope stayed in her purse the whole time. In the parking lot she sat in the car for a minute, and the same thought came that always comes… |
| “Why can’t I ever say what I came to say?” |
| Diane is not a shy woman. She ran the front office of a trucking company for twenty-six years, and she handled angry drivers, late payroll, and a fire in the back warehouse without ever raising her voice. People called her when things went wrong, because she was the one who stayed calm. In an exam room, though, she cannot finish a sentence. |
| So she does what most of us do. She decides the problem must be her. Next time she will be more organized, quicker to the point, better prepared. Maybe a little notebook would help. In the car beforehand, she practices the sentence out loud. And when the same thing happens anyway, the conclusion feels obvious: she is bad at this. |
| Here’s what gets me. |
| None of it was her fault. Diane was never bad at this. She was working against a clock nobody ever told her about. |
| Let me show you how I know. Not with my opinion, but with a study that recorded what actually happens in the room. |
| A team of researchers led by Dr. Naykky Singh Ospina did something almost nobody thinks to do. They went back through recordings of 112 appointments, primary care and specialty both, and they timed the opening with a stopwatch. Only the opening: the part where the patient gets to say why she came in. |
| First they counted how often the patient was even invited to say it. Then, for the ones who got started, they measured how many seconds passed before the doctor cut in. What came back is the most useful thing I have read about a doctor’s appointment in years. |
| What they found |
| Mayo Clinic, 2019. Singh Ospina et al., Journal of General Internal Medicine. |
| When the doctor cut in (11 seconds) |
| In two out of three of the visits where the patient started talking, the doctor interrupted. The middle time before that happened was eleven seconds. |
| When she got to finish (6 seconds) |
| Patients who were left alone said their whole piece and stopped on their own. The middle time for that was six seconds. |
| Letting her finish would have taken five seconds less than the interruption did. |
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| In other words, she was not talking too long. She was done before the interruption even arrived. |
| Diane’s clarity had nothing to do with it, and neither does yours. Six seconds is not rambling. |
| So why does a trained doctor cut off a patient who is eleven seconds into her one sentence? |
| It is not because he does not care. Most of them are running a schedule cut into fifteen minute blocks, and there is a computer in the corner that wants a dozen boxes filled in before he can leave the room. So he listens for the first thing that sounds like a problem he can name, and the second he hears one, his attention goes there. Your bathroom trips become a bladder question. The tiredness underneath them never gets said, because you never reached the third item on the envelope. In only about a third of those visits was the patient even asked what she came in for, and in specialty offices it was one in five. |
| Diane never stood a chance in that room. Neither did you, I’d bet. |
| That’s the part no one says out loud. Nobody handed you a bad personality for appointments. What you were handed was eleven seconds, and no one mentioned the clock was running. |
