In the first large-scale study of how doctors respond to patient clues, researchers at the University of Chicago Hospitals found far more missed opportunities than positive responses in doctor-patient interactions. These included failure to acknowledge a patient's feelings, inappropriate joking and changing the subject-doctors often returning to a medical subject they were more comfortable discussing.

The study in the August 23-30, 2000 issue of the Journal of the American Medical Association examined more than 100 doctor-patient interactions selected from 54 primary care physicians and 62 surgeons in community-based practice. "Doctors feel enormous time pressure and many worry that they just don't have time to address anything but their patients' medical concerns," said Wendy Levinson, M.D., professor and chief of the section of general internal medicine at the University of Chicago. "Our study showed that responding to patient clues did not appear to lengthen the visit."

When a physician offered a positive response to a clue the visit averaged 17.6 minutes versus visits with missed clues which took an average of 20.1 minutes. The researchers also found that when physicians failed to respond to a clue the patient would raise the issue again-usually more than once.

As patients share intimate medical information with their doctors, they often offer clues that put their medical problems into context with their emotional and social concerns. How physicians pick up and respond to these clues can have a profound effect on the formation of a successful doctor-patient relationship. The study analyzed audio-tapes of routine office visits to see how often patients offered clues to their emotional and social well-being and how well experienced physicians responded to the clues.

"We wanted to know if physicians in a busy clinical practice pick up on patient clues and address them," said Levinson. "The growing evidence that patient satisfaction, patient adherence and even biological outcomes can be improved when physicians address patients' personal concerns makes doctor-patient communication more important than ever."

The study found that patients offered clues to their doctors roughly half the time. The issues raised differed in the two different settings. With surgeons, 70 percent of the emotional clues pertained to feelings related to medical conditions. With the primary care physicians, emotional clues were tied to concerns about medical conditions only 20 percent of the time. Psychological concerns, family issues and life stresses were raised in 80 percent of the clues offered to these doctors.

Surgeons appeared as likely as primary care physicians to respond positively to clues-most often by simply acknowledging the patient's concern, as in this example: Patient: Yeah, it gets real frustrating. Physician: Oh, Patient: I used to walk seven or eight miles a day, and now I'm down to. Physician: I'm very frustrated, so I'm sure that your frustration is much more that mine, but I sure would like to see you come out of this without any pain. "We believe that teaching doctors to be better communicators will strengthen their relationships with their patients," said Levinson. "Ultimately good communication can enhance patient satisfaction and improve outcomes of care."