According to the Medscape article, 15-minute visits take a toll on the doctor-patient relationship, physicians and patients alike are feeling a time crunch. 15 minutes per visit is the average, but some primary care visits are shorter. Part of the problem, the article states, is that millions of patients are now seeing doctors for the first time under the Affordable Care Act with an assortment of medical problems that have not been previously addressed.
To make matters worse, many physicians are facing greater financial pressures as reimbursements decline from health insurance plans through the health care law exchanges. Doctors are cramming in more patients to make ends meet.
15 minutes or less per office visit has been the norm for a while, as far as I know, and it has in fact crimped doctor-patient interaction. Effective communication between both parties takes time and so does the relationship that it supports. Studies show that if a patient bonds with a physician, creates a successful partnership, and the patient is an active participant in care, that there is an increase in quality of care and treatment adherence, fewer medical errors, and possibly reduced cost.
I talked with a physician today who has the luxury of spending time with patients. She asked, “How can you reduce the number of diagnostic errors if there is less time to review test results carefully, converse with patients, listen to their stories and perform exams?”
Both patients and physicians are in a bad spot. Health care reform, in some ways, is a controlling wrangler. Patients are flooding the market, there is a doctor shortage, reimbursements are declining, and health insurers are restricting choice of doctors and hospitals to keep costs down. In addition doctors are accepting fewer Medicare and Medicaid patients because of the low reimbursements and high administrative costs.
Where does the patient-provider relationship fall in the midst of all of this? According to The Ochsner Journal, Doctor-Patient Communication-A Review, effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart of medicine and a central component in the delivery of health care. That communication cannot be conducted successfully when a doctor is looking over his/her shoulder at patients lined up in the waiting room.
Which leads some physicians to offer cash-only care and to not accept health insurance at all. This allows them more time with patients. More doctors are now skipping insurance to offer cash-only care. This kind of direct pay from patients has been accelerating as a result of the Affordable Care Act. The unfortunate piece is that many patients cannot afford cash-pay, are stuck within the confines of the 7-15 minute medical encounter, and try to make the most of it. Which is most of us, I might add.
Stanford University Hospital offers virtual doctor visits in their dermatology department as a way to save time and increase access. They claim high quality and low cost. Watch video here.
What are patients to do if they have 7-15 minutes with their physicians?
Tips to make the most of your time with your doctor
1. Come prepared for the visit. Ahead of time, create a list of questions you’d like to discuss with your doctor. This allows you to think about what you want out of the encounter.
2. Come prepared with your top 1-3 medical concerns.
3. Come prepared with copies of pertinent medical records. There’s nothing worse than requesting your records to be sent to your doctor and arriving for your appointment only to realize that your records didn’t show up. This can be a definite time-waster.
4. If you need a new diagnosis, create a symptom diary ahead of time and track your symptoms daily. This includes the time of day symptoms appear, what makes then worse or better, if there was a physical event that accompanied the onset of those symptoms, and when those symptoms started. Share the information with your doctor. This supports your doctor’s efforts to arrive at an accurate diagnosis.
5. Humanize yourself to the doctor. In a few seconds you can let your doctor know a little about you so you will be remembered. Several health psychologists I interviewed for my latest book, The Take-Charge Patient, suggested finding common ground with the doctor such as shared interests, children, grandchildren and activities. You’re establishing a personal connection.
Granted, health care reform offers a number of very positive changes. But there are some issues that need to be retooled to make the new system work for both physicians and patients.