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Observations

Observations

Opinion, arguments & analyses from the editors of Scientific American

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

The views expressed are those of the author and are not necessarily those of Scientific American.

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