Article - Why doctors do not spend enought time with patients anymore?

An interesting article at cheatsheet.com discussing why doctors do not spend enough time with patients anymore. The author has trace the root of the problem back to 1) doctors having tight schedules; 2) patients being interrupted in the first 23 seconds of the examination by the doctor or a third party; or 3) the adoption of the 1992 Medicare formula for “Relative Value Units” aka doctor fee calculations.

Whatever the cause may be, the effect is damaging to the patient’s level of care.

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The article is right, the economics of the health care system in the US today is based on prescriptions written, tests ordered, and procedures performed. The doctor doesn’t get paid for keeping her/his patients well.

A large majority of the diabetes lifestyle changes I’ve made were inspired and based on peer communities like this one. The biggest factor in my blood glucose control is the way I eat. When this issue arises in a medical context, doctors reflexively refer patients to dietitians. Unfortunately the dietitian advice rarely helps produce good consistent blood glucose levels. They’re stuck in a carb-up shoot-up rut. If the patient is not using insulin, the knee-jerk reaction is to add more meds.

The big breakthroughs for me was adopting a lower carb way of eating, exercising every day, and closely monitoring my blood glucose levels. Doctors don’t get paid to provide that counseling. And the medical establishment (including the payers) does not provide effective long term social support to sustain these beneficial lifestyle changes.

Maybe we need to rethink the whole current situation. I don’t need to see my diabetes doctor four times per year but Medicare requires that frequency so it will pay for my insulin pump supplies. I’d be happy with one solid annual face-to-face visit supplemented by one or two Skype calls. Phone and email are other acceptable doctor visit supplements for me. But I’d also like the doctor’s attention when I’m having troubles.

The current situation’s complexity and entrenchment make it difficult to change. Going forward, I hope that the patient perspective be factored into any proposed changes.

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I definitely agree Terry. That’s the relationship my PCP and I have developed over the years. I see him once a year basically so I can get all my referrals renewed and “shoot the breeze”. If I need to see him I know he’s there. My specialists know that I will send them a fax or e-mail with my problems and they, in turn will contact me to either come in for further consultation or call me the medication I need. That’s a good established relationship of patients/doctors who have worked together for long-term and do not need “big brother” dictating x, y, and z of patient care.

This is the residual effects of the HMO establishment of the Clinton administration with the referrals and such. I understand the purpose to reduce excess unnecessary doctor visits by hypochondriacs but in turn it hurt chronic ill people by causing more “busy” clerical work and less true “doctoring”.

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I totally disagree with the central premise which seems to be doctors don’t spend enough time with patients ANYMORE. I’m in my 60’s and I can GUARANTEE you that doctors didn’t spend (other than some notable exceptions) much time with patients in the distant past, either. Having grown up in the military, let me tell you the ill trained doctors were not only incompetent much of the time, but barely allowed one to voice their medical problem before the doc was making a snap judgement, throwing ineffective medicine at one (via an Rx) and ushering in the next patient before you knew what hit you. DITTO, for Kaiser, in the 1970’s. Ditto for many private practice doctors. Only when you have experienced these things first hand, do you get a sense of perspective, as it relates to the term “anymore”. Don’t tell me this is something new. it isn’t. and it has always, universally sucked.

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I guess it has to do with geography and time. I was raised in the 1970s in the rural South with good ole fashioned country doctors. Even though you didn’t see him at his scheduled appointment time (he may be running an hour late), he still took time with each and every patient. He didn’t rush through the diagnosis, listened to the patient, and asked questions. Sometimes he wrote a prescription that even baffled the pharmacist because the pharmacist had to “mix” the medication by hand rather than just pull a bottle off the shelf.

If your had an “affliction” or “condition” that required a specialist he’d “send you up the road” about 50 miles to the nearest town to a specialist or across the border to the next state to the medical center with the latest technology.

So, when I graduated college, got a job and moved to the big city, reality hit that it’s better to stay away from the doctor’s office if you can. You’ll get sicker in the doctor office waiting to be called into the examination room. At my PCP the receptionist has even announced on occasion that the doctors are running 3 hours late and for patients to continue to have patience. I’ve seen cattle treated better at the auction barn waiting to be taken to the slaughter house. SMH

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I’m old enough to remember when doctors made house calls, and they made at least one for me that I remember as a kid in merry ole England.

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Touche. :relaxed: But then again, back in the day, it was a profession rather than a multi-million business with layers of people between the doctor and the patient.

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Yup. Worst experience I had for doctors not spending enough time with me (and just about everyone else), outside of the miltary, was Kaiser. If you could get 10 minutes with a doctor , you would have set a record. It was so bad when I had Kaiser that they would have the door to the exam room opened (in preparation for getting to the next exam room) while I was in the middle of explaining the reason for my visit. Then there was the understaffing that was the direct cause of my son coming out of the womb BLUE, due to lack of oxygen. they didn’t even put a fetal monitor on and labor was lengthy. THAT was because the only available doctor was busy with other patients. Thanks, Kaiser, for jeopardizing my son’s health. I really appreciated it. My mother was threatening them with a lawsuit, things were so iffy for a while. Needless to say, I have nothing good to say about Kaiser, despite knowing that some people just love it.

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I am so sorry to hear what you had to go through with your son, Phoenix. Medical reform is seriously needed–a grassroots effort from the bottom to the top. Unfortunately until someone wealthy loses a relative to negligence or mismanagement, serious reform will not happen.

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remember what happened to Joan Rivers?

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Yep, so true. A coworker and I were talking about that last week, those doctors’ careers are finished due to their hubris and stupidity.

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I don’t disagree, @phoenixbound , but I do remember house calls in the 50s when our family doc lived on the same block–his wife and my mom attended weekly coffee parties together. Time was given as needed.

Sometime in the mi-60s, it changed for me—when I needed a gynecologist, I think…Great discussion…

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While I agree I don’t get a lot of time with doctors, I do try and help make the most of my time. I pull reports from all my machines and send them to my doctors office a few days before my visit. I also email him with a list of things I want to discuss. That way I don’t forget anything and he can look into things before I get their. All my reports I send with notes what I’ve been changing and why and see if he sees something I missed. I find we stay on track and get the most out of the visit. I am also a big fan of email. I always get answers within a day.
There are still doctors out there are willing to spend the time. I had an appointment with my PCP and it went over an hour. Couldn’t believe he was willing to spend the time and let me cry and pour my heart out. There are some really great ones out there.

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My current doctors spend enough time with me. My previous comments were about particular health systems–namely the military and Kaiser (an HMO). Now I’m more concerned with each doctor’s expertise–I know which ones I can count on to give an accurate DX and which ones should be kicked to the curb. :slight_smile: They can be giving of their time, but be inadequately trained. I no longer have to deal with the two health systems I’ve mentioned. :slight_smile: