Doctors Not Allowed to Ask Patients, “How Are You?”

[[{"type":"media","view_mode":"media_crop","fid":"27311","attributes":{"alt":"Pamela Wible, MD ","class":"media-image media-image-right","id":"media_crop_1801506674955","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2632","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 448px; height: 305px; margin: 4px 0px; float: right;","title":" ","typeof":"foaf:Image"}}]]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 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,’ a ‘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 s**t.

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.