Unhurried Conversations in Health Care Are More Important Than Ever: Identifying Key Communication Practices for Careful and Kind Care

To the Editor:

We write in response to the article "Unhurried Conversations in Health Care Are More Important Than Ever: Identifying Key Communication Practices for Careful and Kind Care," by Ballard et al., published in *The Annals of Family Medicine*. As family physicians working in Spain’s public health care system, we found the study’s conceptual framework both insightful and highly relevant. Its identification of key communication practices highlights challenges common to medical consultations worldwide. However, we wish to contribute a comparative perspective, grounded in the realities of family medicine in Spain, particularly regarding systemic pressures that influence the ability to deliver “unhurried care.”

The public health care system in Spain is characterized by universal access and a strong emphasis on primary care, with family physicians serving as the first point of contact for most patients. This model fosters continuity of care, facilitating the development of patient-clinician relationships that align with the principles outlined by Ballard et al. However, our experience suggests that the feasibility of implementing “unhurried conversations” is deeply constrained by the system’s structural and organizational pressures.

A major barrier is the high volume of daily consultations, often exceeding 40 patients per day per physician. According to a report by Civio [1], the excessive workload in primary care has led to a situation where professionals are overwhelmed, affecting the quality of care provided. Such caseloads contrast sharply with the ideals described by Ballard et al., where clinicians are encouraged to engage in shared turn-taking, allow pauses, and moderate conversational pace. While Spanish clinicians value these practices, the limited time per consultation (commonly 5-7 minutes) hinders their consistent application. These constraints are further compounded by administrative tasks, including electronic health record (EHR) documentation, which can detract from meaningful patient interaction.

Despite these challenges, several strategies have emerged within the Spanish context that could complement the model proposed by Ballard et al. First, fostering continuity of care is a key strength of the Spanish system. Family physicians often have long-standing relationships with patients, which can reduce the need for extensive rapport-building during each visit. Longitudinal continuity enables clinicians to recognize subtle changes in patient behavior or emotional state, aligning with the article’s emphasis on open body language and emotional expression. A study [2] published in Revista Clínica de Medicina de Familia highlights that longitudinality and continuity of care are complementary elements that enhance the quality of care, resource utilization, system efficiency, and satisfaction of both patients and professionals.

Second, addressing external interruptions—identified by Ballard et al. as a significant detractor from unhurried conversations—is another area where lessons from Spain may be informative. Innovative models, such as assigning specific times for administrative duties and employing ancillary staff to manage non-clinical interruptions, have shown promise in reducing clinician workload and enhancing consultation quality. The Spanish Ministry of Health's "Plan de Acción de Atención Primaria y Comunitaria 2025-2027" [3]emphasizes the need for organizational changes to improve primary care services, which includes strategies to manage workloads and reduce interruptions.

While the principles outlined by Ballard et al. are universally applicable, achieving unhurried conversations within resource-constrained settings like the Spanish public health system requires systemic reform. Policymakers must address clinician workload and invest in infrastructure that supports patient-centered care. For instance, reducing patient-to-physician ratios and optimizing EHR usability could create an environment more conducive to the practices outlined in the article.

In conclusion, we commend Ballard et al. for their valuable contribution to the understanding of unhurried conversations. Their framework provides a critical lens through which to evaluate and improve communication practices in health care. However, its implementation must be adapted to the unique challenges and strengths of different health systems. Drawing from the Spanish experience, we underscore the need for systemic changes that allow clinicians to fully engage in the practices that underpin unhurried, careful, and kind care.

References:

1. Angela Bernardo et al. (2022). "La excesiva carga de trabajo ahoga a la atención primaria." Civio Sanidad. https://civio.es/sanidad/2022/11/24/atencion-primaria-espana-presion-asi...

2.Añel-Rodríguez, R. M., & Astier-Peña, P. (2022). Longitudinalidad en Atención Primaria: un factor protector de la salud. Revista Clínica de Medicina de Familia, 15(2), 75-76.

3. Ministerio de Sanidad. (2024). "Plan de Acción de Atención Primaria y Comunitaria 2025-2027." Retrieved from https://www.sanidad.gob.es/areas/atencionPrimaria/docs/PLAN_DE_ACCION_DE...