In the past 50 years, the physician-patient interaction paradigm has gradually moved from an authoritarian (patriarchal) physician-led model to a physician-patient collaboration paradigm. In recent years, there has been an increased emphasis on improving physician-patient communication during clinical consultations to provide patient-centered care. Doctors and patients often interrupt each other during visits. What are the causes and effects of these interruptions?
Meaning and Impacts
Interruption is any act that interrupts the flow of a conversation or hinders progress on the topic of conversation.
Interruptions can negatively affect key elements of communication, particularly communicating information to the patient or developing a relationship with the patient. Several studies have indicated that interruptions are frequent while visiting adult clinics, as many as 75% of patients are interrupted by the doctor before they finish speaking. These interruptions reduced the average patient talk time about a medical problem during their initial examination from 73-150 seconds to 12-23 seconds.
Intrusion or Cooperation?
The effect of interruptions on clinical visits remains unclear. Some studies show an essentially intrusive effect of interruptions, particularly when used tactically by a clinician to gain power over the conversation, which can cause a scenario in which the patient is unable to fully articulate their concerns.
The paradoxical view is that not all interruptions are passive, as in scenarios where cooperative interruptions can help maintain the content and flow of interaction. Collaborative interruptions directed by the clinician can also facilitate the coordination of patient care and may even be a show of support and cooperation for the patient.
In general, intrusive interruptions, such as subject changes and disagreements, are seen as more negative and typical interruptions than cooperative interruptions, such as clarifications and agreements.
Gender and Interruptions
Disruptions have long been associated with masculinity and male dominance, although others have questioned this direct link between sex and interruptions. There is no systematic analysis of collaborative and intrusive interruptions at different consultation stages of clinical practice interactions.
Real-world data
One study assessed whether the role of the speaker (physician versus patient) and the gender of the speaker predicted the type of interruption at these specific stages of counseling (first visit or follow-up). On average, consultations took 870 seconds (14.5 minutes), with a range from 275 seconds (4.5 minutes) to 2091 seconds (35 minutes).
For the analysis, the researchers focused on the medical problem presentation and diagnosis or treatment plan stage, since it has special tasks and goals for the doctor and patient.
Interruptions were defined as instances wherein a new speaker started talking during an audibly incomplete turn of the current speaker, which most often involved an overlap of speech.
All consultations experienced at least one interruption, with an average of 29 interruptions per consultation.
Of the total 2405 interruptions identified, 1994 (82.9%) were cooperative, and 304 (12.6%) were intrusive. For the remaining 107 interruptions (4.4%), the type of district was unclear, most often due to inaudible speech.
Patients performed 55.5% of all interruptions, 55% of cooperative interruptions, and 58.9% of intrusive interruptions.
Physicians made the first interruption in 56% of the 84 consultations, an average of 36.3 seconds after the start of the presentation stage, and 89% of these interruptions were collaborative.
Intrusive interruptions were significantly more likely in the following ways:
• By patients than physicians (odds ratio = 3.17)
• By men than women (odds ratio = 1.67)
• In the diagnosis or treatment plan stage than the problem presentation stage (odds ratio = 2.24)
• In the physician group, men were more likely to make an intrusive interruption than women (odds ratio = 1.54)
• In the patient group, men were less likely to make an intrusive interruption than women (odds ratio = 0.70).
Although physicians’ interruptions of patients have long been considered intrusive actions that should be avoided, these findings demonstrate that most of the interruptions that physicians make are not intrusive. The physicians mainly interrupted patients to express understanding and support, or to ask for clarification, thereby aligning with the patients’ ongoing narration and thus with the patient’s role as the primary speaker.
These data support the hypothesis that physicians’ cooperative interruptions in the initial stage of the consultation may improve, rather than hinder, the quality of communication.
Patients interrupted physicians more frequently than vice versa, and more often in an intrusive manner. These results correct the intuitive assumption that it is mainly the physician who acts intrusively during medical interaction. Moreover, male physicians and female patients were most likely to make intrusive interruptions, and female physicians and male patients were most likely to cooperatively manner.
Consultation stage
In the study, clinicians were less likely than patients to intrusively interrupt each other at the problem presentation stage, suggesting that clinicians in this study acknowledged patient control at this initial and critical stage.
On the other hand, in the stage of diagnosis or discussion of a treatment plan, doctors performed almost as many intrusive interruptions as patients, indicating more stress or time pressure, and the frequency of exercising and maintaining authority in conversation.
Briefly
Doctor-patient interruptions are often collaborative actions that may enhance clinical interaction and thus enhance the doctor-patient relationship. Particularly in the problem presentation stage, clinicians’ interruptions to show agreement or to ask for clarification acknowledge the patient’s role as primary speaker, recognize the content of the patient’s story, and demonstrate participation in the interaction.
