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Are doctors getting slower or are patients getting sicker?

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primary care physician visitPeople are going to the doctor’s office more often—and for longer visits than nine years before. So, has care improved or do people just need more medical attention? It’s likely the latter, conclude the authors of a new paper in the Archives of Internal Medicine, published online Monday.

"Two of the most pressing goals for the U.S. health care system are to deliver higher-quality care and to lower costs," authors Lena Chen, Wildon Farwell and Ashish Jha, all of the Massachusetts Veterans Epidemiology Research and Information Center in Boston, wrote in the paper. To see if primary care doctors had spread themselves thin in an effort to do more with less, the researchers studied more than 46,000 adult visits to primary care doctors (the data came from the National Ambulatory Medical Care Survey) over a nine-year period.

"We found no evidence for the commonly held belief that physicians are spending less time with their patients or that quality of care has diminished," the authors report.

As of 2005 there were 338 million visits to adult primary care doctors a year—a 10 percent increase from 1997. Patients received an average of 20.8 minutes of the doctor’s time per visit—up from 18 minutes in 1997. Doctors also spent more time giving common medical diagnoses. Patients receiving diagnoses for arthritis, for instance, had visits that lasted 5.9 minutes longer in 2005 than they had in 1997.

"Although it is possible that physicians are becoming less efficient over time, it is far more likely that visit duration has increased because it takes more resources or time to care for an older and sicker population," the authors wrote. 

Doctor’s visits, however, aren’t equal for all patients. Minorities, including black and Hispanic patients, still received less face time with their physicians. Older adults, new patients and those seeing a general internist (as opposed to a general practitioner) got more time.

Despite the slightly longer and more frequent visits to primary care physicians, "we found only modest improvements overall in the quality of care that Americans received over this period," the authors wrote.

In much the same time (1995 to 2003), primary care physicians’ net income also fell about 10 percent. Continued improvements in doctor–patient interactions may need to be incentivized through additional reimbursement for longer visits; and more efficient technology, such as electronic medical records, should be used, the authors noted.

No word on how much time during office visits might be taken up with patients asking if a drug "is right for" them. Direct-to-consumer television marketing of pharmaceuticals was approved in 1997 (spending on which increased 10 percent each year through 2005, according to a 2007 New England Journal of Medicine study).

Image courtesy of iStockphoto/sjlocke

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  1. 1. myh13140 5:58 pm 11/9/2009

    Patients are NOT sicker and Doctors are slower, but only because of the inordinate amount of documentation required. My office note 40 years ago might have been: Sore throat—–Penicillin. We all knew what a sore throat was and that Penicillin was prescribed. In contrast Today’s visit must include all vital signs, past history, a history of the presenting complaint, history of allergy, plus a rather extended physical exam, otherwise we do not get paid by the insurance companies or the Government. I used to see 50 or more patients a day and see them very well. Now, with all the rules I"m lucky to see 30 and am exhausted after doing so.

    Dr. Michel Hirsch, FP, FAAFP (1967-present)
    Donaldsonville, LA.

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  2. 2. E-boy 6:23 pm 11/9/2009

    Unless there is a third party timing each individual visit instead of ‘self reporting’ by either doctors or patients I’d be very disinclined to trust the reported results. I’ve heard doctors say "self reporting is notoriously unreliable" more times that I care to remember. Seems kind of odd to be so willing to rely on it for a study.

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  3. 3. walburg 6:26 pm 11/9/2009

    I must live on another planet. Nurses have always performed all of the routine stuff like vital signs etc. I am 54 years old and have type 1 diabtes. I have never had a doctor spend more than 10 minutes with me, ever. It’s usually 5 minutes and $70.

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  4. 4. voiceofreason 6:45 pm 11/9/2009

    The first comment is correct. I know from experience. The pervasive growth in documentation and protocol is at fault. This trend, if unchecked, will drive anyone who is intellectually capable of practicing medicine away from the field. The end result is that medicine will become a "rules based system" and a wholly unfit vocation for an intellectual. Too bad for patients. When you arrange a system that can be run by monkeys if they follow the rules, you end up with the sort of results one would expect from a bunch of monkeys. God help us.

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  5. 5. tshilson 9:14 pm 11/9/2009

    For one, people are getting older and fatter. That would requir more and longer visits. Computerizing the paper works can speed things up, once everyone is past the learning curve.

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  6. 6. Spiff 2:18 pm 11/10/2009

    If one includes the document time (even if you are using your family physician who has ALL your records) and the standard 30 to 90 minutes waiting time for a 15 minute $165.00 appointment, one has to admit that the system has slowed down a tad…

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  7. 7. Betty 1:42 pm 11/11/2009

    Very interesting article. It’s good to see that doctors are spending more time with their patients. I’ve been reading about the importance of the doctor-patient relationship in a book called "Time to Care" by <a href="">Dr. Norman Makous</a>. It is based over sixty years of observations in medical practice. This relationship is a critical part of understanding the patient’s medical situation, making a diagnosis, and applying effective treatment. The book proposes bringing the patient-doctor relationship back to the center of the health-care system. Spending more time with patients can only be a good thing. May the trend continue!

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  8. 8. pradhangeorge 4:03 am 11/12/2009

    So is the system in USA improving, with senior nurses and Medics taking over, and the law waiting to pounce, and the doc giving more pen and less hands to the patient. Here in India, because of the increased knowlej of the patients, and the scare the general public and the media raise, the sick person rushes to the doctor, for even a runny nose,not the general doctor but the the very specialist for any thing wrong he sees or others notice. The natural body is not given a chance to control, and so all the tests and so many medicines are used. as a GP since 1951, it seems to me that this is a progress that is in line with all the other pressures that the 2009 man is put to. The quality of the doctors care is up, as well as the stresses the patients face. so what you have noted is but natural sequence.

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  9. 9. Betty 2:14 pm 11/13/2009

    I see that my link did not take, I will try again:

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