Evan Falchuk writes My Reaction to “Putting Patients First”
Most doctor visits feature face-to-face contact with the doctor of 15 minutes or less. Care is increasingly fragmented. Meanwhile, patients have access to huge amounts of medical information on the internet, and feel more comfortable than ever in questioning their doctor. It makes the life of a medical professional pretty difficult. And it makes the life of a patient vying for the doctor’s limited time that much worse.
What’s more troubling is what happens in this set up.
Studies show that 15% or more of patients have their diagnosis missed, delayed or wrong. Others have found that the biggest driver of this poor quality are the cognitive errors that happen when you make complicated decisions with fragmented information and restricted time. Best Doctors data show this happens close to 20% of the time.
The trouble is the way we organize health care today. It systematically undervalues the thinking, processing and deciding aspects of medicine, leaving patients behind.
If we’re going to talk about putting patients first, we have to talk in terms of what is really important to you when you’re sick. You want someone to pay attention to you, think about you, answer your questions, help you understand your condition. You want to be sure you have the right diagnosis and treatment, and above all the best chance to get well.
It’s something I believe we’re all entitled to, first.
Thus, we should really scrap our current payment system and pay for time spent working with and for the patient. Time is the key. When we pay per widget, we shorten the time with each patient, and thus decrease quality care (see my screeds on quality.)
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Explain more what you mean about paying for physician time spent. Are you suggesting that physicians be paid an hourly wage? Would different specialties be reimbursed at different rates? Would a surgeon be paid the same fee for an hour in the operating room as he or she would be for an hour of office time?
The current system encourages 5-10 min office visits and more procedures in less time. If a diagnosis that is not emergent is missed, it can be picked up down the line. Most office visits are limited to 1-3 diagnosis codes, with no rewards to see a patient with a list of 10 concerns. Currently the money makers are the doctors who see 40 or more patients a day to maintain income and lifestyle. Under the current system increases in overhead are covered by squeezing more office visits and procedures into a day. Patients and doctors feel short changed while fees stay fixed by the insurance companies.
Well said.. renumeration for thinking, problem solving needs to be increased to help stave off the abandonment of primary care for the lucrative (ie. “moneyed”) specialties. Evidence based medicine makes a lot of sense rather the excesses of incentive based practice (as many procedures per day as possible; “to a hammer everything looks like a nail”). Unfortunate those specialties (surgical & radiologic) whose clout is over represented in the AMA and will squeal the loudest when their revenue stream is threatened. I do believe physicians should be paid more for taking more responsibility. A surgeon who helps me out at 2AM with a critically ill patient gets my sympathy, not a radiologist reading a “vectored” image from the comfort of home. All this high tech babble as the the answer is over-rated; our VA EMR system is “paperless” but a handshake & a copy of his X-ray wins the day for a bewildered patient in need of the personal connection. Keep the faith…an older emergency physician who still finds medicine rewarding & continually facinating.
In my experience as a patient, the real doctor/patient face time approaches zero. Often, a nurse takes a few measurements of weight, blood pressure, temperature, pulse, and maybe blood glucose. Then the doctor comes in, looks at those numbers, and immediately starts typing prescriptions, with little or no interest in hearing my complaints. The system is broken badly. I’m on the verge of just quitting all doctor visits.
This is so true. Experience has shown me that about 70-80% of the doctors are in a hurry to have you out of the office. I’ve have a few who even seemed irritated that I was there for consultation or kind of rushing things to be done with me.
The key to all of this is to find the right doctor/s for you. There are many good one and also some who are very generous not only with their time but also with their patience and knowledge.
I have been through a lot of doctors over the past 8 years. I’ve noticed that it doesn’t matter what field they are in, there always seems to be some good, and some who won’t give you the time you deserve.
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