The other day, I crossed town during rush hour traffic with 3 small, screaming children after a long day at work to visit my doctor. We sat for over an hour in the waiting room only to be seen by the doctor for less than 15 minutes. I left the appointment beyond frustrated with my short time with the doctor and felt as though I had wasted my time.
The fee-for-service payment model incentivizes healthcare organizations to see as many patients as possible in a given amount of time, and, as a result, physicians often have a mere 15 minutes to diagnose a condition, recommend a treatment, and answer patient questions. In fact, it is very likely that physicians are completing these tasks in less than 15 minutes; one study showed that 52.9% of the time, physicians are talking to or examining their patients and competing paperwork the other 37% of the time.]
But scientific advances coupled with an aging population in which individuals typically have multiple comorbidities have significantly increased the complexity of care. For example, my mother-in-law now takes approximately 6 different pills each day for hyperthyroidism, rheumatoid arthritis, and atrial fibrillation and visits 4 different specialists on a regular basis. According to the US National Medical Expenditure Panel Survey, the number of people with a chronic illness is expected to reach 171 million by the year 2030, with almost one-half of those expected to have multiple chronic conditions. Thus, a 15-minute appointment with an individual with complex chronic conditions will provide little time to adequately diagnose, treat, and educate.
It comes as no surprise that patients are frustrated with this type of “quick” care. But it’s not only the patients who are complaining. While working with doctors to develop educational activities, I’ve realized that doctors, themselves, are frustrated as well. In fact, in a survey of more than 1,000 physicians, 6 out of 10 agreed with the statement “my visits with patients are often too short for me to answer their questions and treat them effectively.”
Although reimbursement systems are moving towards value-based payment models, which might afford physicians more time with patients, it seems that movement is slow. In 2016, value-based payment arrangements represented a small portion of physician compensation.
Until then, here are some steps that clinicians can take to make the most of their time with patients:
- Complete chart prep before appointments
- Delegate various tasks to medical assistants/staff such as lab work, vaccines, and documentation
- Prepare toolkits for common chronic diseases to help maximize patient communication (eg, compile patient resources and information on type 2 diabetes mellitus to review during the appointment)
- Schedule a follow-up appointment for some of the more complicated patient cases so that there will be more time to discuss any results and the next steps of care
- Schedule more time for an appointment with general complaints such as fatigue and weight loss because this will likely consume more time than, for example, an appointment for a sore throat or earache
- Use technology to increase patient‒clinician communication such as patient portals, or HIPAA-compliant apps for texting or emailing patients
- To show they’re really listening, clinicians should maintain eye contact with patients and not type on the computer during the conversation
I’d love to hear from you. What have you or your organization done to help optimize time with patients?