Four days ago Joel Cooper, DO (@joelrcooper) published a blog post titled “Patients: accept your fate as a hamburger”. In it he describes clinical medicine as becoming more and more like a fast food restaurant. As reimbursement for healthcare services continues to decrease providers must see increasing numbers of patients to maintain the bottom line. Given that most providers do not substantially increase the duration of their office hours this means that they must see more patients per hour. As a result, each patient gets less time per office visit. If Dr. Cooper’s perspective were accurate, at some point health care providers would have to “generate business” by creating patient visits that were not medically necessary to keep their schedules full. This bleak scenario is not reality. In actuality, many of us see increased numbers of patients per day to maintain access to care without having “next available” appointments months in the future.
He is right that we no longer see patients as we were taught in medical school. This entailed sitting down with them for 40 minutes or more while eliciting and recording all components of the patient history, performing a complete physical, obtaining laboratory and radiologic studies as well as finally instituting a plan of care. Technology has helped the patient encounter evolve. We now obtain and integrate much of this information into their medical record before we even walk into the examination room. A concentrated digest of pertinent clinical history is available as a part of the electronic medical record. We are able to glean a significant profile of the patient before meeting them. This is not only efficient for the provider but also for the patient who no longer needs to spend a sizable chunk of time with the doctor for each new practice in which they are seen. Size is not the most important factor. Even in the “good old days” a doctor frequently could get a better perspective of the patient with multiple shorter visits rather than one long visit – the same applies today.
Overall, I don’t think the absolute duration of the encounter is as important as the quality of the time spent with the patient. We can and do make proper diagnoses and provide excellent treatment during shorter patient visits. Most patients don’t mind that the doctor only spends 15 minutes with them as long as a genuine connection is made, understanding of their problem is shown and quality care is provided. Efficient care does not have to treat patients as fast food hamburgers; if done well, each patient can be a petite filet mignon.