Sunday, November 15, 2015

When medical care is delivered in 15-minute doses, there’s not much time for caring - The Washington Post

I have 15 minutes. I'm generally not happy that, as an internist who works for a large medical group (most of us do now), I'm instructed to conform to this assigned length for visits with my patients. Being told to arrive at 2:45 p.m. makes it clear to patients that every doctor-hour is broken into quarters. But the pressure to keep to the time limit is felt primarily by the doctor, who must stick to the schedule or expect the 3 p.m. patient to come in unhappy about the wait.

A patient in any medical practice rightly wants the visit to take as long as is reasonably required. A healthy 25-year-old with a sore throat is thrilled to be out of my office in less than 10 minutes, after a focused exam and a culture. Most patients, though, don't present a single problem that can be addressed with a targeted answer. The 15-minute visit shortchanges those patients while frustrating the doctors who want to help make them well.

Marvin is thin, 6-foot-4, a 36-year-old commercial mortgage broker with a lineless, hard-to-read face. I've seen him once before, 11 months earlier, so this is considered a follow-up visit, half the length of a 30-minute first encounter.

There's a typical sequence to a 15-minute visit. In the opening phase, researchers who have studied primary-care interactions expect that I would "establish a cordial atmosphere" and "convey interest," and in fact I talk to Marvin about the Yankees' pitching problems. In the history section, I gather data with yes/no questions and tell-me-more-about-that follow-ups. "My back's acting up," Marvin says. Back pain is one of the 10 most common patient complaints in primary care and is almost never life-threatening. This shouldn't take very long if I'm clinically efficient and a clear communicator. Still, I try not to show that I am in a hurry. I do not wear a watch. Did your back pain begin after an injury? I ask. Have there been pain-free days? Are there certain positions or medications that have afforded relief? "It's been bad the past couple of months," Marvin says.

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