Doctors not allowed to ask patients, “How are you?”

Medical Insanity

Another indication that health care is sick—doctors are being told to stop asking patients open-ended questions like:

“How are you feeling?”

“What worries you?”

“What’s on your mind?”

Today a physician just e-mailed me:

“I am really, really overwhelmed right now.  What happened to me at work this week was grim, even before our dreaded production meeting.  I can feel tears welling up. Reason:  Many times I have tried to incorporate friendly pick-me-ups like a smile, a handshake, a ‘thank you for coming in to see me today,’ an ‘it was wonderful to see you today’ at the end of patient visits. My standard opening line has always been some version of ‘What brings you in today?’ I’ve always felt a source of pride that I can ask open-ended questions and still get to the bottom of most issues in a short visit. My production meeting yesterday pretty much squashed all those niceties out the door.

We are now to be double-booked [two patients per appointment slot] to ‘make our production quotas.’ Our regional director (not a doctor) reinforced the decision by our medical director (an MD under the thumb of the regional director) that we are NOT to ask open-ended questions in our visits but to let the medical assistants who room the patients identify the SINGLE issue that they are coming in for and THAT’S IT.  So we basically need to shut down to whisk them through the door.

You know as well as I do how ridiculous and futile that is and how fast care like this destroys what’s left of the therapeutic relationship. I now have to figure out a way to work even faster while still being caring and compassionate.  I am in a really shitty position.”

My plea to doctors: please stop taking this shit.

Pamela Wible, M.D., is a family physician and founder of the ideal medical care movement. Watch her TEDx talk on ideal care. If you’re a doctor, join the physician teleseminar and learn how you can stop suffering and start practicing real medicine. Photo by GeVe.

Posted in Ideal Medical Care, Patient Relationships, Physician Abuse & Bullying Tagged with: , , , , ,
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26 comments on “Doctors not allowed to ask patients, “How are you?”
  1. GirlfriendMD says:

    Luckily, I’ve never been told what I can and can’t ask patients, but I have been told to focus on a single issue per visit and ask the patient to come back, at increased cost to the patient, and endless frustration.
    When I was leaving that practice, my previous employer threatened to sue if I told patients I was leaving (despite it being my ethical duty and obligation to notify patients of my departure) because I would “damage his business.”
    I let him know that he was doing that without my help already by thinking of it only as a business. I get it that there are costs to manage and time constraints to balance, but one CAN see patients, do a good job, be ethical and still make a living.

    • Dr M says:

      RE 1 visit 1 problem.

      Fortunately, I had this advise from an admin physician when I worked at an HMO; it lasted 1 visit, and I never returned to that model.

      Unfortunately, you may be faced with this question in the future if you do not work for yourself.

      Good for you that you had the strength to walk away.

      Hope for those who are thinking the same thoughts.

      Dr M in Western PA
      Solo since 2004
      FP residency completed 1988.
      6 years staff model HMO.
      8 years hospital owned practice (which has had 5 docs in the last 10 years since I left).
      2 years working in a physician owned practice when I started out, which dissolved when the doc didn’t want to collaborate with the 2 of us “employed” docs.
      That should add up!

  2. Nelson says:

    I left my residency program after 1 week. I left every job I had feeling that I had failed.
    I now have a private practice. I enjoy my work. I take care of patients the way they should be taken care of, like a human being. I realized that I was not the problem. The system is not only broken, it is antithetical to good patient care. It is focused more on making money. Do what is right, quit your job, start a practice. So you will not be rich but you will be happy.

    • Pamela Wible MD says:

      You can also be rich and practice medicine properly and ethically if that is your goal. Most doctors are not driven by money. They are driven by meaning and caring for people.

  3. Mark Hantoot, MD says:

    As a physician in practice for 20 years, I am grateful every day for the courage of folks like you who stand up for what makes medicine a mission worth pursuing. We only allow our patients to be victimized when we allow ourselves to be victimized. My generation rolled over. I’m confident yours won’t!

  4. Patricia Allamon says:

    I told my healthcare org that I was burnt out and could only see 20 pts per day. I had no resistance, thankfully. The decrease in my pay is incremental when you calculate taxes. My patients, staff, and I are happier. So thankful for your Tedtalk, maybe one day I’ll get my own place. Today- so much better! Thanks for caring and speaking up.

  5. Young Doc says:

    I’m with Nelson! Enough is enough! I too have left the madness behind, but am feeling disheartened by these types of stories that I keep hearing – is there a way for those of us who have “made the leap” to help out those who haven’t yet? While I (and others) have stood up and said “I refuse to accept this for myself,” I’m now starting to wonder if we also have some sort of collective public-health obligation (referring to the health of our colleagues who are still trapped as cogs in the industrial medical “machine,” as well as to that of their patients, who are the vast majority of Americans) to unite and take a stronger stand. How on earth did it come about that some of the most highly-educated people in this country allowed a bunch of bureaucrats with checklists and patient satisfaction scores to bully us (and our patients) into a corner like this? (And then there is this lovely MOC thing on the horizon… More bureaucratic BS… ) Argh. Ok, enough ranting for now. To the person who e-mailed Pam: get out! find a way to start your own clinic! you can do it! and you *WILL* PROSPER!

    • Pamela Wible MD says:

      Yes. We do have an ethical responsibility to save our ailing colleagues. Would you stand by and watch someone jump off the Golden Gate Bridge and do nothing? I know of a doc who lost 7 colleagues to suicide. What other profession loses so many and does nothing? We actually need to go out and befriend our suffering colleagues and help them back from the ledge. Absolutely. Call a few today. Check on them. Take them out for coffee or tea. Talk. For real. Listen to their silent cries. Only we can stop this madness.

      • Young Doc says:

        OK, thanks for the ideas. You are certainly doing your part by shedding light on this with your blog and keeping the rest of us energized. Thanks for the good work & keep it up – for all of us!

    • Dr M says:

      Yes, like Pam has, say hello, watch others, talk with them about their days.

      Dr M in Western PA
      Solo since 2004
      FP finished residency in 1988

  6. Young Doc says:

    A little (but ONLY a little) tangential, but I am still feeling “ranty.” Saw this article this morning about medical errors contributing to patient deaths:
    I immediately thought back to this blog post and thought to myself that as long as this kind of mentality persists, those numbers will only continue to rise…

  7. That’s why I had to let it go. I was destroying my sense of self worth diagnosing people for profit.

  8. maria Bowmer says:

    I have seen two of my doctors leave for those reasons. One burnt out , he used to be so nice but all the pressure on him changed that. Then my other female doctor that I loved went to greenfield health. Patients pay a annual fee or 50 dollars a month for no waiting , and access to the Dr. whenever . I am thinking of going there instead of Ohsu where I go now. I usually get 40 minutes with the doctor , which really is about ten and if its a 20 minute appointment , thats about 5. The Dr. that went to Greenfield was the best. Sometimes I was in there an hour , she hooked me up with social services, with counseling , all kinds of things that no one ever mentioned to me before . She cared and that is probably why the powers that be told her to move along .I really love your blog . I sure like to see nice caring doctors here too. I would love to see everyone have a doctor they like and trust , and also doctors who arent pushed for quotas. Loved that goat pic too.

  9. Tammi Miller says:

    I am not a physician, I am a patient, and all I can say is “WOW”!! Unbelievable!

  10. This makes me sad. The point of being a doctor is to help people and they’re effectively telling doctors not to do that, or to do it as little as possible per bill.

  11. Al says:

    Luckily, my wife and I are in practice together and see 10 to 15 patients each and we are done by 12 noon. We can take as much time as we want with our patients. I have friends that work ‘under contract’ etc. for hospitals where productivity is the bottom line. I can’t practice medicine like that and either should you. Take a handle of your own medical practice and do what you feel is ethical and right without the pressures of a bottom line.

  12. I know most of your talks are aimed at physicians, but I am a nurse practitioner who feels the same way you do. I am accused of talking too much with my patients about personal things like how their lives are actually going. I know all about their family issues, what’s stressing them out etc. and they know mine! My heart aches to be able to sit on a couch and diagnose and have a real relationship with my patients like the good old days! I heard a fellow coworker say once that she had absolutely no interest in getting to know her patients and she had no intention of ever sharing any of her personal life with them. How sad and arrogant!

    • Pamela Wible MD says:

      I think this all applies to anyone providing health care. I don’t like the word “provider.” We can all be healers if we can give up being victims.

  13. April says:

    Yeah, they stared playing the 3 issues per visit game in residency. I explained that I’d limit it to 3 new issues maybe, but I’m not asking a person to have 3 separate visits every 3 months for their 9 chronic medical issues. People simply wouldn’t tolerate it! They’d get 1/3 of their issues or less dealt with every visit. It’s horrid what production line medicine has done to my profession.

  14. BW says:

    I agree will you wholeheartedly but how about the plight of sub-sub-specialists who can only function within a complicated institutional structure. I am a seasoned internist by training and experience and qualified/practiced in 3 continents but my passion was for hematological malignancies and bone marrow transplantation. I am also a clinical/translational investigator; I don’t have a lab but collaborate with basic scientists to develop drugs and complex cellular products and take them to clinical trials. It is extremely demoralizing to see the “institution” being not supportive, and sometimes hostile and antagonistic, not only for revenue but for favoritism and hidden agenda!! I am ashamed to say but if our patients know what really happens in the background, they will be mortified!! I always had been a believer in being a patient advocate, even when I do research, I take their interests at heart and that the doctor-patient relationship is the center of the, so called, “health care solar system”!!! I believe, and sometimes I am gently reminded by patients and their families and other colleagues, friend, and my own personal family, that my “work” is very important! I can’t do my “work” without the infra-structure of the organization that I hate and loathe!! Is there is any salvation for ME? Or am I destined to, consciously, remain locked in that virtual world analogous of the 1999 Matrix movie!!!

  15. S says:

    I was a Primary Care physician for 10 years, and I was absolutely miserable. I hated my job and the way insurance companies tied my hands. No way one can deliver good medical care in 5 to 10 mins and being a ‘bean counter’ for the insurance company. I left primary care, went into Integrative Medicine, opted out of medicare, started my own practice. I now spend an hour with each patient, and, although I am making less money, am much happier.

  16. JD says:

    I feel incredibly lucky, as a patient with several ongoing and tightly intertwining medical issues, to have a wonderful NP at a practice that doesn’t appear to have the absurd notion that it’s possible to address “only one thing per visit,” and yet provide anything whatsoever of real value to the patient.

    If only we could make the bean-counters call things what they are:

    “From now on, you will be required to diagnose and treat patients without actually seeing, examining, talking to, or asking questions of them. At no time will you be in the same room with them. Should you accidentally see a patient in the hallway, you must look the other way immediately. Failure to do so will earn you five demerits.

    “During each five-minute appointment, you must accomplish the following: record in your laptop the presenting complaint. Only one symptom per visit. No more of this time-wasting business of ‘fever AND rash/headache/sore throat/broken arm/nail in head, and the like. Identify the single most important symptom, and ignore the rest. You will probably be surprised at how easy this becomes with no actual patient in the room. It’s the Future! We’ll be rich, I tellya; RICH! No, not YOU, doc, US! Your managers! Business is business! You don’t need actual patients to make money! You just need RECORDS! And the simpler, the better! Geez, how’d you doctors survive before you had us MBA’s to run things!

    “Now, then, where were we … “

  17. Kathleen Hurd, MD says:

    I am making under 100k per year, but it is allowing me to buy my building, have 30-60 minute appointments-12-14 a day-my own quotas. Right now I have one regular staff member and no medical assistant. I see Medicare and Medicaid. I bill insurance. I live in one of the areas that has lower fee for service due to archaic medicare rates for location. I thought I would burn out when I couldn’t find a qualified medical assistant, but instead I am feeling better than I have for a long time. I feel closer to the patients, more confident in my life and though it is weird to be getting less revenue and turning away new patients, the financial dip I had with the assistant is recovering. I have compassion for the providers who must support debt and family commitments with the high salaries this type of assembly line medicine provides. I encourage them to get financial counseling -Dave Ramsey Financial peace university is a resource. This may be better than a high brow financial planner. As a society we need to respect those who choose to make less, live a simpler life, and focus on the quality of their work and the relationships that they have. I still struggle with the pressure of family and society on me to “produce more”. Like many of you, I am a brilliant physician and they think there must be something wrong with me if I am NOT making the big dollars. Unlike dr. Weibel, I only spent one year working with others telling me how to run my practice. But I too have struggled time finding my place, because I thought there was something wrong with me when I didn’t make a lot of money. I realized that I make enough. Once I accepted that, I have really found joy in my work! Sure, I want to learn more and get smarter at this business, but what I’ve learned listening to Dr Weibel and reading her materials is that smarter is sometimes less. I honor her ability to accept us as professionals in whatever way we practice and encourage anyone who is struggling to take the webinar.

  18. Mary Cudworth says:

    All I can say is never let them take away the main reason you chose to be in be in healthcare. That is who you are and once they have that….what is left of you ? Many times the only thing that got me through the day was my dedication to the patients. I had to use that as my excuse to continue on, despite the inner workings and politics of working in a hospital. No one appreciated me or my dedication so I had to find a way to continue for the patient and myself to get through each day. I had to do it for myself and my sanity.

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