JANUARY 2017 ON HEALTH CONSUMER REPORTS 11 CONSUMERREPORTS.ORG/HEALTH M y first year of medical school included a class in doctoring, where we were videotaped and then graded on our performance. The grades weren’t based on medical profi- ciencies such as arriving at the correct diagnosis, however. Instead, the empha- sis was on how well we paid attention, listened, and responded to what our patients were saying—basic skills every physician must develop. In the years since, electronic health re- cords (EHRs), email, and text messages have become ever-present distractions. And the list of regulatory requirements, meant to show we’ve met quality stan- dards, improved care, considered cost, and used technology meaningfully, is growing longer. As a result, I often find myself look- ing at my computer screen instead of my patients’ faces. I’m not alone, either. A Northwestern University study pub- lished in 2014 in the International Journal of Medical Informatics found that primary care doctors who used EHRs in the exam room spent about one-third of the time looking at them; doctors who utilized paper charts looked at the doc- uments for 9 percent of their patient’s visit. A September 2016 report in the Annals of Internal Medicine found that for every hour doctors are face-to-face with patients, almost two more are devoted to EHRs and desk work. HOW DISTRACTION CAN HURT The current system puts doctors in a time crunch, with patients the unintended casualties. And if your doctor is trying to attend to your EHR in the midst of your office visit, his focus may be divided. Ac- cording to the Northwestern study, when doctors used EHRs in the exam room, they were more likely to miss important nonverbal cues. That can make it harder for doctors to arrive at a correct diagnosis. Proactive Patient Here, what you can do to get your doctor’s attention when you need it: CHECK THE DOC’S ATTENTIVENESS The unfortunate reality is that doctors are distracted by competing agendas these days. For example, a patient came to me last year in distress because her long-term physician, out of the blue, had asked her whether she was being physically abused (she wasn’t). He was probably trying to comply with a requirement—that he document the per- centage of patients over age 65 who had experienced maltreatment. Doctors are being asked to record a host of similar “quality care” measures and, although well-intended, they often divert us from the problem at hand. To determine whether your doctor is engaged, note whether she is asking appropriate questions during your visit. (If a question seems odd, ask for the reason behind it.) Reflective questions—such as “How long has the pain been present?”— are a good sign she is listening and con- sidering what you are saying. Think about whether you’re getting enough time to express your concerns as well. Body language offers other clues. An attentive doctor will try to make eye contact, face you squarely, lean for- ward, tilt his head toward you, and nod in agreement. GETTING YOURSELF HEARD To help keep the focus where you want it: à Plan your visit. Decide what you are go- ing to say in advance (write it down if you need to). Present your top two or three complaints, emphasizing what’s bother- ing you most and why you are there. à Bring a friend or a relative. He or she can help you remember what you want to say, take notes, and ask questions. à Sum it up. Just before you leave, the doctor should recap your diagnoses, tests or procedures to schedule, and treatments or medications prescribed. If she doesn’t, do so yourself. Repeating and rephrasing what you’ve heard can give you confidence that she understood what you said. This information should also be included in the patient summary you receive as a printout or by email. à Speak up. Nothing gets my attention more than a patient who lets me know I’ve been sidetracked. Most doctors appreciate it when a patient says, “You seem distracted today; I don’t feel like you’ve been listening.” We want you to feel heard, and we all need a reminder now and then when we’ve failed. ORLYAVITZUR,M.D.,M.B.A., is Consumer Reports’ medical director. Board certified in neurology, she is a fellow of the American Academy of Neurology, a clinical instructor at the Yale University School of Medicine, and a medical consul- tant to the New York Rangers hockey team. Is Your Doctor Attentive? How to make sure you’re getting both the care and concentration that you need Your doctors want you to feel heard—and we all need a reminder now and then when we’ve failed. Orly Avitzur M.D., M.B.A. ILLUSTRATION: DAN BEJAR/THEISPOT.COM