Blogging is an interesting experience. Some weeks I struggle for content, and never feel that I have said anything substantial – all solid, but modest nonetheless. This past week, I dealt with some very important issues. As I pondered these rants (which I rate as better than usual), I understood that they share some commonality. I am ranting about the current problems in delivering high quality medical care – and how I would change things were I given the power.

In many ways, Saturday I summarized a major concept of this blog – The Starling curve and patient volume. In this rant, I postulated the obvious. We function best with enough patients, but not too many. Using reductio ad absurdum, everyone will agree that I cannot effectively see 1 patient each minute. Thus, there must be a number of patients which leads me to compromise good care. It is harder to prove that I am a better physician seeing 10 patients each day, then only 1, however, I believe most readers will accept that postulate.

Given these absurd anchors, we must work to estimate the appropriate amount of time to allocate for each patient. I am not aware of anyone doing research in that area, and yet I am happy to argue this question as fundamental.

One way to increase patient contact – while controlling time – is through technology – An idea whose time has come.

Our current reimbursement pays physicians for each visit. It does not consider the time needed for a visit – but rather arbitrarily designates a set fee. These fees have no relation to expenses, or increasing overhead. The office visit is the big loser in this system. Thus, primary care becomes less attractive every year – Why students do not elect primary care careers. Our lack of sufficient high quality primary care leads to excess ER visits – The ER is full.

Medicine really does take more time in 2005 than it took in 1975 (my internship year). We can, and should do more at each visit. Yet in 2005, we have too few physicians – No doctor glut — Oops!

As a physician with 30 years experience, I continue to be astonished at the lack of logic in considering health care. We have planners who make pronouncements without understanding the moving target of health care. We have insurers who undervalue the doctor patient interaction, almost forcing physicians (for financial reasons) to spend inadequate time with each patient.

Our health care system needs a dose of common sense. Unfortunately, I doubt that our political processes will allow us to develop a thorough consideration of these issues – thus, we will limp along – from crisis to crisis.

Related posts:

1. The future of general internal medicine
2. The future of outpatient internal medicine
3. I think the internet is the future of medicine
4. The future of CME
5. Family medicine vs internal medicine

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