It turns out that a simple conversation may improve outcomes in primary healthcare. Check out this recent NY Times piece by a primary care physician.
It’s nice to see an article that includes both research and observations from clinical practice. Real-world experience so often differs from study findings.
I think it was in the early 80’s that we began to experience pressure on healthcare managers to make more efficient use of limited staff. After all, staff costs money (65-70% of a clinic’s operating budget), and to make each individual more productive, the emphasis shifted to seeing greater numbers of patients. That translates to brief visits and tighter schedules.
For instance, one large provider set a target of 12 minutes for a patient visit. That doesn’t leave much time for conversation. A practitioner who met this target would receive a bonus. One who did not would get a plan for improvement. And perhaps, eventually, be replaced.
Problem is, as the article suggests, this may actually reduce treatment effectiveness, particularly with chronic conditions. A doc who’s watching the clock is far less likely to expend valuable time chatting with a patient.
We’re told that perhaps 100 million Americans suffer from chronic pain. Most of them wind up in primary care clinics. At what point in a 12 minute visit would a physician stop to go over alternative methods for pain control? Easier just to add or renew a prescription for opioids. The insurance company probably won’t object– meds are still a relatively cheap option, in comparison to more labor-intensive treatments.
A family practitioner in a busy clinic may see four to six thousand patients annually. That’s a lot of sick people. Makes me wonder if this question appears on the customer satisfaction survey: “Do you feel as if you spent enough time with your doctor?” And “Did you have a chance to ask questions and have them answered?”
If not, that’s a good place to begin.
