Tuesday, July 29, 2014

The 15 Minute Visit to the Doctor's Office

Medical problems can be complex. They have the potential of altering our lives completely and for good and even the power of terminating life. Physicians have devoted a huge proportion of their lives to understand medical issues and to learn the art of palliate if not cure disease. 

Ideally, we should visit a doctor for prevention, advise end general education regarding health problems. The duration of the visit should be determined by the nature of the problem and by the complexity of the tools needed to solve it. Nowadays, in most settings, it is almost impossible to do that. Physicians watch the clock, not because they want to leave and go home, but because there is another patient waiting. And after that patient, there is another and another. All of them can carry problems of similar complexity. Is it fair to squeeze the 13 years of training that a specialist has (not counting the many years of experience after that) into 15 minutes of patient talk? 

An office visit, has the following elements: conversation with the doctor, physical exam, analysis of laboratory values, another conversation to report the physician’s ideas, prescription of medications, ordering further tests, documentation of the encounter and in many occasions, an interaction with the insurance companies to seek approval for certain medications or tests. Is it possible that a good job could be accomplished in 15 minutes?, in 30 minutes? 

This is one of the reasons why the doctor’s office has become a revolving door of patients who come for a prescription refill from a doctor who struggles to keep the practice afloat due to low insurance reimbursements. This is the reason why many complex problems remain unanswered, this is the reason why diagnosis can take longer to be achieved and the reason why so many unnecessary  tests are ordered. This is one of the reason of polypharmacy, medication side effects and medication errors.

What can be done? Nothings substitutes good professional advice. This is why, in order to have a question properly answered, the internet should not be used. It should only serve to seek for a good physician. Second medical opinions provided by doctors that devote the proper amount of time to the medical problems are an invaluable tool that will help not only the person looking for the answer, but also the primary care physician who initially did not have the right amount of time to deal with the issue.

Marco A. Ramos MD