Speaking and interruptions during primary care office visits

Background: Patients and physicians value effective communication and consi der it an essential part of the medical encounter, This study examined phys ician-patient communication patterns, and interruptions in communication, d uring patient visits with family practice and internal medicine residents. Methods: Observational data obtained from 60 routine primary care office vi sits included the time that resident physicians and patients spoke and the number and types of interruptions. A total of 22 family practice and intern al medicine residents participated, 9 from family practice and 13 from inte rnal medicine. Results: Patients spoke, uninterrupted, an average of 12 sec onds after the resident entered the room One fourth of the time, residents interrupted patients before they finished speaking. Residents averaged inte rrupting patients twice during a visit. The time with patients averaged II minutes, with the patient speaking for about 4 minutes. Computer Else durin g the office visit accounted for more interruptions than beepers. Verbal in terruptions, a knock on the door, beeper interruptions, and computer use al l interfered with communication, and increased frequency of interruptions a re associated with less favorable patient perceptions of the office visit. Female residents interrupted their patients less often than did male physic ians. All residents interrupted female patients more often than male patien ts. Early and increased interruptions were associated with patients' percep tion that they should have talked more, Third-year residents interrupted pa tients less frequently than did first-year residents. Conclusions: Numerous interruptions occurred during office visits. Gender was associated with th e pattern of interruptions. Physicians frequently interrupted patients befo re the patients were finished speaking. Computer use also interrupted physi cian-patient communication.