The egg-timer office visit

Sad, but not surprising – as doctors cram more patients they see during the day, staying on time is a must:

Some of Dr. Trent Dusang’s patients have transferred their medical care over to him because their old doctors would set an egg timer at the beginning of their visit, then leave when the buzzer went. Time was up . . .
. . . While egg buzzers in doctors’ offices are rare, more doctors are posting signs asking patients to limit the number of medical issues dealt with in a single office visit to one.
One woman, who had trusted her doctor with her health and that of her family for 25 years, complained to the College of Physicians and Surgeons of Alberta. She had been discharged from the doctor’s practice because she often came in with more than one health problem.
The sign in her doctor’s office read: “Due to a significant increase in patient waiting times, the doctors in this office will ONLY deal with ONE medical problem per office visit. If you are not in agreement with this policy, we will be pleased to transfer your medical record to another physician of your choice.”

Comments

SarahW
more doctors are posting signs asking patients to limit the number of medical issues dealt with in a single office visit to one.
That’s crazy bad medicine, bad for patients, bad for practitioners. I would warn them what time is saved with patients may end up being spent in the company of attorneys and insurance adjusters, or worse.
Anirban
Accepting everything whatever you say ,SARAH can you show us a way-out. Pt queue getting longer and medicare payment being cut year after year .Some one has to eat the humble pie.Agreed this is bad medicine ,can we have some suggestions to make it a good one .
NocturnalDoc
I constantly had people come in with lists of 10-20 “complaints,” ranging from chest pain to 30 years of low back pain. 95% of the people I saw reacted negatively to the gentle suggestion that we address 2-3 of the more serious problems now and work down the list in subsequent visits. People want everything they want and they want it now! To heck with everyone else in the waiting room.
See that bitterness? That’s why I left primary care.
CJD
Anirban, why should we PATIENTS show you a way out? You guys are the ones on the front lines. The only legislation you ever bring to the table is capping damages in malpractice claims. And in 30 years of that stuff, you haven’t changed anything about how healthcare is delivered, nor have you lowered healthcare costs for the patients or increased your income or at least improved the quality of your practices.
If your reimbursements are declining, they’re not funding you in a manner that allows you to practice good medicine, etc., why aren’t you proposing something? Anything? What would you suggest us patients back in terms of legislation that will improve those things?
Anonymous
It’s hugely sad and depressing that this is what we’ve come to. And yes, it’s not entirely surprising. As long as the only approach to controlling healthcare costs is to cut reimbursement to physicians and hospitals, stories like this will be more and more common. Most of us physicians hate what we’re having to become.
Okulus
This is totally predictable and should not be at all surprising. What is amazing is the expectation of suspended reality that patients have of the time used and the refusal to acknowledge that time is what costs, and that consuming more of it should cost them more. This is the result of having a third-party payment system that shields patients from the reality of their consumption. By removing the brake of personal payment responsibility, or by limiting it to artificially low “co-pays”, there isn’t any incentive to prioritize.
You want solutions? Here are a couple: insurance companies and Medicare need to pay better for the services they claim they do cover. If they want to save money, then cut whole procedures (and none of that “bundling” crap that is just another dirty unfunded mandate). Then patients will get the advance beneficiary notice that what they are about to consume will be on their own dime. Copayments need to be scalable: if it costs no more to present five problems than it does to present one, then go for it. In the end, if you take up two appointment slots with your problems, then you need to fairly pay for two slots.
Patients don’t want to hear that there is no such thing as a free lunch, and third-party payors, once they have their premium payment have no incentive to tell them. So who is going to do it?
anonymous
The fact of the matter is that the demand for health care services continues to rise, fueled by new technologies, increasing expectations, increased longevity, and increased disease (diabetes especially). This increased demand equires greater expenditure of resources.
If demand increases as payments per encounter or service decrease, the choices are to be more efficient in some manner or spend less time per encounter. The efficiency of providing medical care is one thing that has not improved. Patients want time to converse with their doctor and have their questions answered. Physicians have more tests to order, procedures to perform, and medications they can prescibe. Add the bureaucratic morass of managed care, verifying insurance, HIPPA forms, documentation requirements, etc. and things become ever less efficient.
The issues for everyone concerned include consideration of how much time and money to spend on health care, how much choice is desired, where to draw the line on services covered by third party payors, and how to improve efficiency in delivery of healthcare.
Reactions to the current situation include the subject of the article. I view such responses in a negative light, but it really all about scarce resources and how to distribute them. Concierge medical practice is another reaction. I think it has its place, but will not deliver speciality care nor care for the masses. Limiting ones scope of practice can produce certain efficiencies of scale and standardize care to an extent.
Old fashioned face-to-face time with a physician is very expensive and with decreased payments by third party payors will become less and less. Instead of physical exams as we know them, maybe we will have asssembly-line exams (height, weight, blood pressure, pap smear, ekg, and plebotomy performed by allied health providers). A report will then be generated by computer with physician review, e-mailed to our homes, and follow-up recommended determined by evidence-based medicine and economic cost/benefit statistics. Further procedures, studies will be done by highly subspecialized providers with standardized and streamlined protocols. Drugs will be prescribed by formulary protocol, not doctor or patient preference. This will be the new government mandated standard of care. For anything else, you must have additional insurance or pay out of pocket.
CJD
Okulus, when will your lobbying entities start putting some legislation up to enact your proposals?
Criminallopath
Yet another example supporting the contention that more medical schools should be opened – free of the limiting restrictions of the CME. This form of behavior would never be tolerated in any other profession as the consumers would quickly put the offending service provider out of business by leaving en masse to the horde of providers waiting down the street. Can you imagine if your auto mechanic tried this? How quickly would you find yourself at the next mechanic down the street? The healthcare market needs more competition amongst the providers such that the providers are begging for patients, and not the current system. In any event, this is the system that the sheeple have allowed to be imposed upon them. They should just shut up and take what the providers dish uot to them.
chucky
My experience in primary care was 3 years in the military. Retirees would come to their 15 minute appointment with a years list of medical complaints and concerns. The spouse, who didn’t have an appointment, also had a list and wanted those addressed “because I am here”. What finally did it was when I was woke up one sunday morning by a patient who apparently got my number through base information and wanted to know the results of their cholesterol test.
No more primary care for me.
anonymous
Realistically my family spends as much on auto associated costs per year as health care, and my mechanic gets paid cash at the time of service. There are no discounts and my mechanic does not accept insurance; he sets his own prices. My mechanic drives a Mercedes-Benz. There is no call or provision for emergencies. If my battery dies I will just have to wait until the shop opens. I love and trust my mechanic nonetheless, and he has earned the AAA seal of approval.
You are right! Maybe physicians should be more like mechanics.
lawyersux
“My experience in primary care was 3 years in the military.
I was thinking of applying for a job at a military base or VA hospital. I heard that protects you from the sodomites. Does anybody know if it’s true you can’t be sued if you work at a V.A> or for the military?
CJD
I thought you were going to Europe or Canada or something? Or was it getting out of medicine altogether? Your stories are hard to keep straight.
anonymous
I’m sure our troops in Iraq or Afghanistan would graciously accept your care, and that suing you would be the last thing on their minds. There are a lot of Saddamites, but they will just lop your head off you make a mistake.
Anirban
the best way is physicians should unionize and collectively get out of the plans, what ever that is . A concierge pratice at an affordable rate would be a better idea , but it will require big solidarity among physicians in primary care. With years of HMO experimentation the hard facts that we have learned that they will never put the money where the mouth is , and only enrich the CEOs . What ever the condition of the HMO the CEO compensation never goes down. It will be far better to expunge all the third parties from the whole process. It is sad that primary care providers have never been allowed to unionize and collectively bargain for the rates ,courtsey the washington lobbyists and ACP-ASIM and Pundits in RWJF always dishing out the politically correct craps , to the detriment of the physicians ,I think PCPs better wake up and smell the coffea,and get a better leadership or just perish . there is no way out.
anonymous
Unionization is not the answer. Larger practices with market power to match that of the insurance companies and economies of scale are what is needed. Insurance companies are so large that they exercise market power, and in any other sphere of enterprise would be potentially subject to antitrust regulation. That said, be aware that Medicare is the ultimate monopoly, and private payors following Medicare extend this monopoly power. Good luck bringing an antitrust action against the federal government!

The egg-timer office visit

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