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So Many Patient Complaints, Not Enough Time

Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit.

It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type:

… a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of paper on that Thursday morning in my office with a brisk snap, and my heart sank as I saw 30 lines of hand-printed concerns.

Ms. W. told me that she had recently started smoking again, after her elderly mother became ill, and she was up to a pack a day now. She had headaches, eye pain, pounding in her ears, shortness of breath and dizziness. Her throat felt dry when she swallowed, and she had needling sensations in her chest and tightness in her gut. She couldn’t fall asleep at night. And she really, really wanted a cigarette, she told me, nervously eying the door.

This is the kind of patient who makes me feel as though I’m drowning.

Dr. Ofri did as many doctors do: She listened appropriately, went over the patient’s history and physical, reviewed prior tests, and concluded that many of her symptoms were due to anxiety. Except, in this case, they weren’t. The patient eventually had a pulmonary embolus, and hospitalized. Read more »

*This blog post was originally published at*

How Patients Can Enhance Communication With Their Doctors

From Kevin Pho’s medical blog, KevinMD, a post archived from 2004, Pho talks about the struggles of communication between doctor and patient during the 15-minute office visit.

Pho sites a New York Times article that explains that more than two decades ago, research shows that patients were interrupted 18 seconds into explaining their problem (on average) and less than 2 percent got to finish their explanations.

Pho sites that he sometimes falls into the “interruption trap,” saying: “I think this is a natural progression to our managed care environment. Physicians are compensated by quantity of patients seen, and are kept to a strict schedule -– in most cases every 15-minutes.” Read more »

*This blog post was originally published at Health in 30*

Saving Primary Care: What Will It Take?

“Bold changes are needed in how the United States delivers and pays for primary care if the key goals of national health reform are to be achieved,” according to the health policy journal Health Affairs, which has released a thematic issue devoted entirely to the crisis in primary care.

(The complete articles are available only to subscribers, but Health Affairs’ blog has a good summary.)

I have spent much of the day reading the journal — 47 articles, and a combined 300 pages of text. Here are my “take-home” messages from the articles. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

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