Improve Care With a Great Conversation
The conversation is key, the rest is...
Dr. John Buse, MD, PhD, from the University of North Carolina, School of Medicine, shares how he cuts through the growing cluster of paperwork and prioritizes conversations and joint decision-making with his patients.
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I think the conversation is actually more important to the outcome than anything else that you do in the visit.
It is challenging when you have very little time in a patient visit to engage in a lot of conversation. But the way I think about it is that everything we else, everything else we do in the visit is really, in some ways, kind of a waste of time. I mean, we do need to find out if people have diabetic neuropathy, but we don’t have to obsessively do it at every visit. We do need to look over glucose logs, but that’s not the only thing. For me, it isn’t about coming up with a great note, it’s about coming up with a great conversation.
I think it’s really important to not only ask relatively open-ended questions like, “How are you doing?” and “Are you having any problems with your diabetes?” It’s even more important to take the time to really listen to the patient. Often what happens is, as a provider or in any walk of life, you throw these questions out there but then you don’t even really listen to what people say in response because you’re at the same time trying to enter data into your electronic health record and the like. At the end of the day, the realities of billing and documentation consume a lot of our time, but the truth of the matter is that they don’t really have to.
I love it whenever a patient asks me a question because it creates an opportunity for shared decision-making around their therapy. The most important thing is to listen for what it is that the patient is concerned about.
So, I try and be very quick in assessments that I really feel need to be made at every visit—checking their blood pressure, seeing if their weight is up or down, reviewing the medications and side effects—but, at the end of the day, it’s the conversation that you have that makes the difference in the care of the patient. And frankly, that’s why diabetes educators are so valuable. They’re going to have a 30-minute or 1-hour conversation, when you’re going to have a 5- or 10-minute conversation. But the conversation is key. The rest of it is bookkeeping.