Blog | Friday, October 13, 2017

Patients need more time with their physicians, and vice versa


One of my favorite songs of the 60s, Does Anyone Really Know what Time it is?, and the song has a great line “Does anyone really care?”

Both patients and physicians really care. My friends, neither physicians nor my patients, often tell me stories about brief visits. Occasionally I hear praise about a physician who really spent time and listened. My physician friends often lament that they do not spend enough time with patients, and research confirms that. A wonderful piece in The BMJ makes the point brilliantly, “Margaret McCartney: Why GPs are always running late“?

An intelligent, kind friend says to me, “My general practitioner is always running late—why?”

I try to explain that her GP is probably similar to me. Even arriving early and staying late, I still only have about 12 minutes for each patient. And I have to fit a lot into those 12 minutes.

As a colleague puts it, general practice is based on a lie—a lie that we can do this safely and well in 10 minutes. I reckon that acceptably safe practice would take double that, and excellent practice would need more again to ensure that everything's in place for proper, shared decision making.

No one goes into medicine for an easy life. But I'm haunted by a feeling of persistent failure. We need to know: what expectations can we realistically have of the time currently available to us—and how much more time and resources should we really have to do it well?

What happens when we try to see patients too quickly? We must take short cuts, take less careful history, cheat on the physical exam, try to avoid extra questions, order tests rather than spend more time interviewing, or obtain a consult to do what we might do with enough time.

This article comes from Great Britain and their wonderful National Health Service. It is slightly less bad in the U.S. Electronic health records have worsened the problem because charting takes much longer.

Many experts believe that inadequate time leads to diagnostic errors. Others (as the article suggests) note that shared decision making takes time, and too often we do not have adequate time to have those discussions.

We waste resources trying to cram too many patients into the physician's day. We cannot say this often enough. This is not a doctor issue; this is a patient issue. Patients suffer when we shorten their visits.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.