After 31 years as an ABFM board-certified family physician, Dr. Keith Wright wasn't looking for a problem to fix. His practice was already one of the highest-performing offices in his health system for patient experience. Patients trusted him. Satisfaction scores were excellent. By most measures, things were working exactly as they should.
Yet when an opportunity arose to participate in the Implementing Diagnostic Excellence Across Systems (IDEAS) project from the RAND Corporation, he volunteered anyway. RAND is a national nonprofit, nonpartisan research organization.
"I knew we had great patient experience scores in general," Dr. Wright said. "But there's always room for improvement. We don't know everything. I'm sure there are blind spots that we have."
Dr. Wright discovered the project wasn't ultimately about improving a score; it was about becoming more intentional in how he listens to patients.
What Might I Be Missing?
The project was part of a broader effort built around tools designed to help physicians better understand patients' concerns and improve communication. The first component asked patients to identify their main concern before a visit. The second component encouraged physicians to allow patients time to speak uninterrupted at the beginning of an encounter.
During the project, a mother brought her child to the office for what appeared to be a routine ear infection. Before entering the exam room, Dr. Wright reviewed the information she had provided ahead of the visit. To his surprise, the mother's biggest concern wasn't the ear infection itself. Her child had a history of febrile seizures, and she was worried it would happen again.
"I would not have picked that up," Dr. Wright said. "I think through my questioning, that would have just gone over my head."
That visit reminded him that presenting symptoms and underlying concerns are not always the same thing. Patients often arrive with fears, questions, or experiences that may never surface if they aren't given the opportunity to share them.
Even for a physician at the top of his game, the takeaway was a reminder that one’s professional experience does not rule out discovering something new.
Listening Without Interrupting
The second component of the project proved even more valuable. Physicians were encouraged to allow patients at least 60 seconds of uninterrupted talking time before beginning to guide the conversation. The approach was based on a 1984 study, which found that physicians who interrupted patients did so, on average, within 18 seconds of the patient starting to speak. ¹ Like many busy family physicians, Dr. Wright initially wondered whether allowing patients to speak freely would consume valuable time. Instead, he found the opposite: most of his patients finished sharing what mattered most in well under two minutes.
The experience challenged an assumption he had carried for years: that the physician interrupting was sometimes necessary to keep a visit efficient.
"If we just let them talk for the most part, I think we're going to find out more than if we interrupt them and try to guide them down a certain pathway."
The project's metrics showed no measurable change, since patient scores were already high at the start and stayed high at the end. Dr. Wright believes something still has changed: he is more intentional about how he approaches patient conversations. Today, he still makes a conscious effort to let patients finish their thoughts before redirecting the discussion or moving to the next question. This behavior change has meant more to him than numbers on a page ever could.
Fast Doesn't Mean Rushed
After 31 years of practice, Dr. Wright is still looking for things he can learn from other physicians. One reason the lesson resonated so strongly is that it challenged another common belief among physicians: that listening carefully requires significantly more time. Dr. Wright points to a colleague who consistently receives exceptional patient feedback despite seeing patients in relatively short appointment windows.
"He sees patients in 10-to-20-minute increments," Dr. Wright said. "And you ask patients, how is he? And they say, 'Oh, he took a lot of time with me.'"
The observation continues to intrigue him. In fact, he has expressed interest in shadowing that colleague to learn more about how he creates that experience. His curiosity may be one of the most telling parts of this story.
The project reinforced his belief that listening is not necessarily at odds with efficiency. In some cases, understanding a patient's real concern from the beginning may save time by preventing misunderstandings and uncovering issues that might otherwise remain hidden.
Family Medicine Is Relational
At its core, Dr. Wright believes the lesson extends beyond communication techniques and goes to the heart of family medicine itself.
Family physicians often care for patients across years or even decades. They care for children, parents, and grandparents. They help people navigate illnesses, life transitions, and uncertainties. Those long-term relationships create a foundation of trust that is unique to primary care.
"The more you get to know a person, the better the care will be and the better the outcomes will be" Dr. Wright said.
Trust allows patients to share concerns openly. It encourages questions. It helps patients feel comfortable discussing sensitive topics and following through on treatment recommendations. For Dr. Wright, relationships have become increasingly important throughout his career. "Everything that makes the world go round is based on relationships," he said.
The performance improvement activity did not fundamentally change that philosophy. Instead, it reinforced it. It reminded him that one of the best ways to strengthen relationships is also one of the simplest: listen carefully.
Growth Doesn't End With Experience
For physicians who view performance improvement activities as simply another certification requirement, Dr. Wright's experience offers a different perspective. The value was having an opportunity to pause, reflect, and examine how he practices medicine. Rather than numbers or data, for Dr. Wright, the lesson was more personal. It was a renewed appreciation for listening and a deeper understanding of how small changes in approach can influence patient trust and continuity of care.
After more than three decades in family medicine, Dr. Wright remains convinced that some of the most important learning happens not through mastering a new clinical guideline, but through continually refining how we care for the people who place their trust in us.
And perhaps that's the broader purpose of lifelong learning: not simply to measure performance, but to do better tomorrow than today.
Dr. Keith Wright is a family physician in eastern Pennsylvania and has been an ABFM board-certified family physician for more than 30 years. He would like to extend a special thank-you to the people who make his good work possible, including his nursing, front office, and clinical staff. The American Board of Family Medicine would like to thank Dr. Wright and his staff for their dedication and hard work in improving family medicine in their community.
Citation:
Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101(5):692-696. doi:10.7326/0003-4819-101-5-692
https://www.acpjournals.org/doi/10.7326/0003-4819-101-5-692