Hold That Pause
Hold That Pause

You Have "Peri" What? : More From The Empowered Patient

A doctor plugging their ears. Photo courtesy of iStockphoto.comIn my last post in this series I recommended the book The Empowered Patient by Elizabeth Cohen, CNN senior medical correspondent. However, if you still need a little convincing, I thought I might share with you a personal experience I had right after I read the book last year. It’s about the eighteen/twenty-three second rule (Cohen, 2010, p.44).

According to a 2001 study, the average time a physician spends with a patient is eighteen minutes. In 2012, I wouldn’t be surprised if that time is now even shorter. But, in 2001, it was eighteen minutes. According to the rule, during the eighteen minutes a patient has to describe symptoms and discuss her health issue, she will be interrupted by her physician after approximately twenty-three seconds with a question or a comment. 

According to Dr. Howard Beckman of the University of Rochester who actually documented this, it is something physicians deliberately do called “redirecting.”  It is a method by which the physician maintains control of the time he has with you, in order to maximize the opportunity to give a diagnosis. Unfortunately, what often happens when you are “redirected” is that you also lose your train of thought, and are not able to give a complete and thorough explanation of your symptoms. 

For example, let’s say you are in your physician’s office trying to describe your symptoms of perimenopause.  After twenty-three seconds she interrupts with questions like this:

“When exactly do you get the hot flashes?”

Or, “How old are you?” 

Or, “When was the last time you had your period?” 

Of course, these are perfectly plausible questions that you should answer. But guess what else happens? You stop speaking, and within a few minutes a diagnosis or opinion is given, and you are walking out of the examination room not knowing anymore than you knew when you went in.

Sound familiar?  You bet it does.

Right after reading The Empowered Patient last year, I had an episode of what I thought was cardiac related chest pains.  Given my age (mid-fifties), and my family history of heart conditions, I decided I should go to the ER to have myself checked out. 

I sat feeling vulnerable and scared in my little white paper gown for only a few minutes when the young, energetic cardiologist came into the examination room.  He sat down, glanced briefly over my chart, and asked how I was feeling.

I began to explain to him what I had experienced earlier that day: pain in my chest, a dull, aching sensation which ran from my neck down into my left arm, a bit of nausea, and then it happened: He interrupted me with a question.

Now, I didn’t exactly time it, but I did recall immediately what I had just read weeks before in The Empowered Patient.

“Aha!” I said to myself. “There it is! The eighteen/twenty-three second rule!”

So I answered his question, and quickly jumped back to what I was trying to explain. As it turned out, I didn’t have any issues with my heart. Perhaps this would have been the case whether I had known about the eighteen/twenty-three second rule or not. I can’t say with any certainty. 

But I can say for the brief moment I was sitting on that table feeling vulnerable and scared, I also felt like I had some measure of control over the healthcare I was about to receive. Was it a tiny victory?  Yes, it was.  But, remember ladies, that’s exactly how we’re going to take down the wall - one brick at a time.

Magnolia Miller is a certified healthcare consumer advocate in women’s health and a women’s freelance health writer and blogger at The Perimenopause Blog. 

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Tags: Books , Perimenopause

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About the Author

Magnolia is dedicated to empowering women to take responsibility for their own health.