Doctors' Dilemma: One Eye on the Patient, One Eye on the Clock

Doctors' Dilemma: One Eye on the Patient, One Eye on the Clock

01-03-2017

At a recent family gathering, a woman shared a stunning story that many people would consider a violation of medical ethics. She told of a cancer doctor who was fired because he wasn't seeing enough patients on a daily basis.  

But, it wasn't because he was spending too much time on the golf course. The problem, according to his superiors, was that he spent too much time with patients.  

He was told to keep appointments to 15 minutes and despite warnings, he continued giving patients quality time. For that, he was let go.

Sadly, similar stories are playing out across America.  

Doctors are increasingly pressured to see an almost untenable number of patients each day.  Many conform to these new standards, and the effects are being felt by doctors and patients alike. 

Joan Eisenstodt told Kaiser Health News that her appointment with an ear, nose and throat specialist lasted less than five minutes.

"He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone," she said.

When she raised a question about the medication the doctor suggested, "He just cut me off totally," she said. "I've never been in and out from a visit faster."

The root of this dilemma is largely financial. Doctors need to see more patients to make ends meet as their overhead costs rise.  They're forced to hire more staff members in order to handle the mountains of red tape, while at the same time, medical insurance reimbursements either decrease or do not rise high enough to cover the physician's costs.

"Doctors have one eye on the patient and one eye on the clock," said David J. Rothman of Columbia University's College of Physicians and Surgeons.

The loss of doctor-patient face time is perhaps most critical among residents, the so-called doctors-in-training.  According to The New York Times, regulations capping the hours residents are allowed to be on the job, which are designed for their safety as well as their patients, are forcing new doctors to cram their work into fewer hours.  That means interactions with patients can often shrink to an average of eight minutes per visit. 

"It's really astonishing that so little time is spent at the patient's bedside," said Dr. Kathlyn E. Fletcher, an associate professor of medicine at the Clement J. Zablocki Veterans Administration Medical Center. 

Dallas primary care physician Anthony Lyssy told CBN News that doctors and patients deserve better. 

"I can't do anything effective in eight minutes except throw a prescription at you and tell you to come back and see me in two weeks if it doesn't work," he said.

Dr. Lyssy chose to work for Diamond Physicians, a concierge practice.  His patients pay a monthly or annual out-of-pocket fee instead of using health insurance.

His practice, like most concierge practices, has a much smaller case load than insurance-based practices, which means patients get more attention from the doctors.

"I meet with my clients for about an hour every time they come in," he said. "Even if they're coming in for something acute -- a sinus infection, an ear infection -- I take that time to talk about wellness, nutrition, fitness, overall elevation of health."

Lyssy said the average case load for insurance-based primary care physicians is 3,000 patients, whereas concierge practices average about 500.

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