As many of my readers know, I speak at meetings and conferences fairly frequently, and most often to groups of patients and caregivers. The focus of the talks I give is usually on a patient empowerment topic – ranging from how to communicate with your doctor, to how to stay safe in the hospital, to a dozen other topics….
Every time I speak to groups of patients, I ask the question, “Have any of you ever felt rushed during a doctor appointment?”
The overwhelming majority raise their hands, and nod, and often turn to the person sitting next to them, poised to share their latest horror story about being rushed, which is often the case after they’ve waited in the waiting room for way too long. A double whammy.
Frustrating. Maddening. Unfair. And now, statistically accurate, including its negative effect on both our health and our wallets.
Newsweek Magazine published an article this week called The Doctor Will See You – If You’re Quick. Written by Shannon Brownlee (author of Overtreated), it quantifies the problem of, what I call, “drive by doctoring” – the concept that we barely see the doctor walk IN the exam room door, before the doctor has retreated back out that door, asking the empty hallway (because he’s no longer engaged with the patient at all), “Do you have any more questions?”
The point to the article (which is excellent – you really should take the time to read it in its entirety), is that over the past few decades, the trusting relationship that used to exist between patients and their doctors has eroded to almost non-existent, and has resulted in bigger problems for both parties. And both parties are suffering. Patients don’t like it, and their doctors don’t like it either.
Or (another one of my sayings) – American healthcare is not about health or care. It’s about sickness and money – using sickness to make money.
Here are some of the points that support that:
- The ideal patient panel (number of patients) for primary care doctors should be fewer than 1,800 patients in order to provide the kind of care patients need. Today, the average number of patients per PCP is 2,300. And for “Medicaid Mills”, the panel is more like 3,000.
- To speed things along, doctors interrupt their patients an average of 23 seconds into the answer to the question, “Why are you here today?”
- One study showed that the average amount of time spent providing “critical information” to patients is 1.3 minutes (yes – that’s MINUTES.) Your quality or quantity of life only deserves 1.3 minutes?
To those of us who understand this madness, and attempt to be smart patients, there is nothing new here. But the information is beneficial to us for a few reasons:
First – because our world is being driven more and more by data, and not simply our observations and stories. With the quantification of these kinds of problems, the powers-that-be will have to look at solutions, because no nation can afford sicker and poorer people.
Second – because this kind of information is a good reminder to us all that it’s us SMART, EMPOWERED PATIENTS who will manage to get the best of a system that has the capability to be great, but is growing worse every day.
We can’t help those who won’t help themselves… but we can be the ones who will STOP this erosion, and help ourselves.
• Helping ourselves will mean we find the right doctors – the ones who WILL communicate with us. (A reminder that no doctor is average – they are either better than, or worse than, whatever average is. As empowered patients, we search out the “better than”.)
• Helping ourselves means we place ourselves squarely in the middle of our own medical decision-making – we don’t default to letting someone else make them for us.
• Helping ourselves means we find information to support our decisions, making sure it’s credible and reliable.
• Helping ourselves may mean that we try to manage our relationships with our doctors on our own, or it may mean we ask someone else to help us.
• Helping ourselves will mean understanding the roll the pursuit of profit takes on our health – we will understand the concept of Follow the Money and why that makes us poorer and sicker.
It took decades for the healthcare system to devolve to what it is today (just in time for us baby boomers to utilize it in huge numbers with, in too many cases, horrible outcomes.) It will take decades more to fix it.
Most of us don’t have decades to wait – and for that reason alone, we must engage in our own care. We can’t afford, for our health OR our wallets, to let drive-by-doctoring take its toll on us or our loved ones.
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I am so fortunate to have physicians (currently) who do not fall into this category. But, I have visited with some who were overextended with their patient load. It was quite obvious, and I’m glad I was able to move on to a more diligent and concerned physician. I realize there are so many people who are stuck with doctors like you have described, and that’s a shame.
After many years of being a provider in healthcare I feel as a patient helpless and hopeless in this “driveby doctoring” issue. I totally agree that it is the American healthcare system that values this – you can barely get eye contact away from the computer screen from physicians. People just don’t know how to speak up. Thank you Trisha for doing this.