Office-based practices are focusing increasingly on patients 45 and older, reports the Centers for Disease Control and Prevention.
In 2008, those 45 and older accounted for 57 percent of all office visits, compared to 49 percent in 1998. Prescriptions, scans and time spent with the doctor also became increasingly concentrated on those middle aged and older, according to data from the CDC’s National Center for Health Statistics.
Also, physician visits increasingly concentrated on medical and surgical specialists and less on care provided by primary care practitioners for those ages 45 and older. Furthermore, for patients ages 65 and older, the percentage of visits to primary care specialists decreased from 62 percent to 45 percent from 1978 to 2008, while the percentage of visits to physicians with a medical or surgical specialty increased from 37 percent to 55 percent. Read more »
*This blog post was originally published at ACP Internist*
Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.
– From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”
Internists, I expect, will identify with Edward Bear.
Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.
Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.
Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.
Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »