Unfortunately, when it comes to primary care medicine, time is not on the patient's side. According to a study published in the Annals of Family Medicine by Valerie Gilchrist, MD and her colleagues, primary care physicians spend nearly a third of their time on non-patient activities. What's the solution to this time crunch?
Some have suggested health plan consolidation might relieve the administrative burden on physicians, giving them more time to devote to patient care. This may help, but not as much as you think. The Gilchrist study found that the majority of time physicians spent on non-patient activities was devoted to charting and dictating.
Since none of the physicians interviewed by Gilchrist and her colleagues used electronic health records, I wondered whether technology could increase time with patients by increasing efficiency. However, as NY Times columnist Pauline Chen warned, there is a risk that the use of electronic medical records results in more time looking at a computer screen, not at patients. This is especially worrisome when you consider that today's informed patients want more time to discuss medical information with their physicians, not less.
A third option is more promising: increase the number of physicians. The Patient Protection and Affordable Care Act contains incentives to expand the primary care workforce. And in Massachusetts, Robert and Myra Kraft, owners of the New England Patriots, recently announced the donation of $20 million to Partners HealthCare to increase the number of primary care clinicians in community health centers.
It may take several years before these changes have an impact. In the mean time, we can't let time become the enemy of compassion. At a Schwartz Center symposium in November 2010, Dr. Tom Lynch, Director of Yale Cancer Center, noted that some of the most compassionate healthcare he's seen is in the emergency room--where physicians are able to connect with patients they don't know in minutes.
What's your solution for making more time for patients?
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4 comments:
I don't see an easy solution to this problem, except that we need to train and hire more physicians so each will have sufficient time to examine patients carefully and answer their questions. Additional ancillary staff would help too, so that doctors can focus on the non-administrative aspects of patient care.
Either way, it's a matter of willingness to spend more money for better care by physicians.
Hi Elaine,
I agree we need to increase the supply of physicians and ancillary staff. Presumably this will take some time. I'd love to hear your ideas on how we address this patient time deficit in the interim.
Thanks for your comment.
Julie
I beleve we need to develop a different payment system for PCP docs. We are working under a sytem that pays for face to face encounters and not much else. Many of the patients I see each day really did not need to be seen face to face, yet we are driven to this to get paid. If we could get paid for non encounter care, we could have more time to spend with the folks that really need face to face encounters.
Hi Greg,
You make an excellent point about face to face encounters. With the advent of technology patient care may be delivered in a variety of ways, not just in person. Dr. Ron Dixon of the Virtual Office project at Massachusetts General Hospital estimates that as many as 60% of office visits could be handled virtually. Virtual office visits, he points out, also have some advantages over face to face encounters. Here is a link to an interview with Dr. Dixon on our local public radio station which you might find interesting:
http://radioboston.wbur.org/2010/08/31/online-doctor-visits
Thanks for your comment.
Julie
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