How do we make the most out of medical appointments?

Note: This interview was originally published in Doing Well, a health news outlet from ASU Media Enterprise and ASU Learning Enterprise. Subscribe to Doing Well to get interviews with health experts delivered to your inbox weekly.

By Mia Armstrong-López

In the U.S., 76 million people live in places where there are too few health professionals to give them the care they need. Across the country, people wait weeks or months for doctor’s appointments: on average, six weeks to see a gynecologist, more than a month to see a cardiologist, and more than three weeks to see a family medicine doctor, according to a recent survey.

To fill these gaps, the U.S. needs to rapidly train thousands more health professionals — by one estimate, we need at least 187,000 new physicians by 2037 — a mission Arizona State University has recently taken on with the newly established ASU Health system.

In the meantime, staffing shortages mean that doctors and other health care providers are able to spend less time with their patients. Changes in the health care system itself also mean they have additional burdens to carry — from navigating complex insurance reimbursement setups to managing online patient portals. Health care workers have to answer for frustrations with the health system that are often outside their control — and, tragically, they are five times more likely to experience violence than workers in other sectors.

Addressing the health care provider shortage will take time, money and lots of high-quality training. But while those larger challenges are addressed, patients need tools to get the most out of the limited time they have with health care providers now.

To explore those tools, and how staffing shortages affect both patients and providers, we spoke to Dr. Joseph Sirven, chair emeritus of the Arizona Mayo Clinic’s department of neurology and a professor at ASU’s College of Health Solutions and John Shufeldt School of Medicine and Advanced Medical Engineering.

Note: This interview has been lightly edited for length and/or clarity.

Question: How do shortages in the health care workforce affect patient experiences?

Answer: When you have a shortage of doctors and other folks that see patients — nurse practitioners, physician assistants — more people have to be seen by those who are currently working. There’s only a certain amount of time in a day. The number of people that you have to see increases, and you end up seeing a lot of patients in a short amount of time. The doctor is not always happy with that. The patients aren’t happy, because they feel rushed. So it affects the whole system; it makes appointments shorter and more stressful.

Q: More stressful for everyone. I think it’s fair to assume that most health care providers go into the profession because they want to help people, they want to make them feel better. But the nature of the system means they have a lot of other work to do, a lot of other people and tasks that they have to respond to. How do these stressors affect your experience as a provider?

A: Number one, there’s pressure to see a lot more people in a given day. If you’re sick (as a provider), you feel guilty. Someone has to answer phone calls, and eventually those questions come to you. There’s a patient portal you have to answer. If you’re in a situation where you also have hospital-type work, there may be on-call duties and splitting your time between different locations. You can see how suddenly (it) becomes an easy ride to burn out.

Some will immediately counter with, “Well, yeah, but doctors and providers are compensated well.” That may be true, but if you ever look at the loan burden for students — they’re up there. You are very much trying to just keep your head afloat. I love what I do, but that is a reality.

The other thing that’s happened is that it used to be that doctors were very much in private practice settings, in little offices. Those still exist, but many, many more have now been purchased by large health groups, hospitals, even insurance companies. That puts extra pressure to balance budgets — and, sometimes in that pressure, things get lost.

Q: Many people have had the experience of waiting months to see a specialist for a 15-minute appointment, or being in a hospital and waiting all day for the five minutes that a physician might have on rounds to see you. How can we make the most of the limited amount of time that we may have with a health care provider?

A: Here’s a sad truth about the entire system: We spend more time waiting for the doctor than talking to the doctor. We have to find a way to fix it. Having said that, there are things that can make those visits really important.

The way I view it is that it’s not about getting the appointment; it’s owning the appointment. The first thing I always say: Be prepared. That means have in your head: What are my top two or three things that I want to get addressed today? Not a novel — you’re going to have to kind of think journalistically: What’s the headline?

Before you get into that office, those forms you have to fill out — medications you’re on, history, allergies — those are gold. Don’t fill them out in the office, have them prepped before you get there. If you’re talking about blood pressure, have a log of (your) blood pressure; if you’re talking about migraine headaches, (create) a calendar showing how often. Those are data points.

I think of my mom — I remember she’d always get dressed up for the doctor, and then I told her, “Well, how’d it go?” “It went great.” “Well, what about this?” “Oh, I didn’t talk about that. I didn’t want to ruin his day.” I’m like, “Well, that’s not going to get us the answer.” Don’t worry about our feelings and how you look; just tell us what you need to address.

Take notes, or bring an advocate or an ally. I truly believe in having an extra pair of ears. When you’re stressed because you’re meeting someone, or it’s so personal, or maybe it’s painful, sometimes you forget stuff. So bringing that person or taking notes really makes a difference.

The last thing I’d say is: Understand the plan. In other words, when you hear whatever they suggest in the treatment, say, “So, you’re telling me: Do XYZ.” That’s a way of checking for misunderstanding, especially with medications and things of that sort. If you have a follow-up, that’s a good reason for the patient portal.

Q: There’s nothing more frustrating than waiting for an appointment, and then driving home and realizing you didn’t get what you needed. One thing I’ve felt was helpful in the past is to practice talking about my issue with a family member or friend beforehand.

A: I love that idea. The other piece to this is just making sure you jibe with the (provider). Even if you waited for a while, if they’re not going to listen to you, then that may be a reason to search for someone else. You don’t have to put up with feeling not heard.

Q: You’re a neurologist; you specialize in epilepsy care. Epilepsy and a lot of other neurological conditions like stroke require quick care and decision-making. For patients and family members, that can be scary. How can family members make sure they get the information they need while also ensuring providers can do their jobs?

A: In emergency settings, I’m going to double down on having someone with you. Someone who’s going to be extra eyes and ears, an advocate. When you don’t have that, one of the other sources is nurses. They’re extremely busy too, but one of their roles is to connect in that manner. Treat them as an advocate for your safety. If you don’t have someone, take notes and ask to record things.

Q: If I am the advocate, what should I focus on to do the best job I can for the person I’m trying to support?

A: The best thing is asking (yourself): Does it make sense? Asking for something to be repeated: Can you say that again? Can you go over that? The medication, how long will (they) be on it? Can you explain those symptoms?

You don’t want to speak for the patient, because we want to hear from them, but you may want to say: Hey ... what about that thing you told me the other day? As long as it’s not breaking confidence, that helps (put together) the whole picture.

Q: What do you wish all patients knew about the pressures health care providers are carrying?

A: Number one, we are under immense time pressures. Until the system changes — and I’m still optimistic it will, to where we’re off of time-based billing and more about outcomes — there’s a lot of pressure. Number two, know that in the vast, vast majority of cases, the doctor wants to help.