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Got Two Minutes?

Laurie Barclay, MD

Sept. 30, 2002 - Doctors need to wait just two minutes or less for their patients to tell their story, suggests a report in the Sept. 28 issue of the British Medical Journal.

"Doctors do not risk being swamped by their patients' complaints if they listen until a patient indicates that his or her list of complaints is complete," write Wolf Langewitz and colleagues from the University of Basle in Switzerland. "Even in a busy practice driven by time constraints and financial pressure, two minutes of listening should be possible and will be sufficient for nearly 80% of patients."

Earlier U.S. studies suggest that doctors jump in and begin asking directed questions after only 22 seconds, on average, of listening to the patient's history, most likely reflecting their belief that it would be time-consuming to allow the patient to speak too long without interruption.

In this sequential cohort study, 335 patients at an outpatient clinic in Basle were asked to talk spontaneously about their complaints and to indicate when they had finished. Doctors timed their initial history with a hidden stopwatch, and interjected with questions or comments only after the patient said "What do you think, doctor?" or some similar phrase.

Spontaneous talking time was 92 seconds on average, and it was less than two minutes in 78% of patients. Gender and social status did not affect spontaneous talking time, but histories in older patients tended to be longer. Only seven patients (2%) spoke for longer than five minutes. Because the doctors believed in all cases that their patients were providing important information, they did not feel the need to interrupt them.

"We gathered data in a tertiary referral center that is characterized by a selection of difficult patients with complex histories," the authors write. "Patients in less selected groups may need even less time to complete their initial statement."
BMJ. 2002;325:682-683