Dear patient: Your 5-minute appointment is awaiting you.

Dear patient: Your 5 minute appointment is awaiting you.

Dear patient:

I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.

I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just need a physical exam, we will do this in 20 minutes. I am told easier things should take more time.

However, if you would like to talk to me about the fact that you have lost 30 pounds these last three months, have a past history of cancer and you’re not sure if you want chemotherapy again, this should take only 10 minutes because your concern is just “weight loss.” I am not allowed to make special accommodations for your concerns; if I do, I am giving away care and contributing to the current health care crisis. I am also not to consider the fact that you traveled 60 minutes, took unpaid time off from your job, or spent half your day arranging for childcare to see me.

Because of these schedule enhancements, I will likely rush through our time together and gloss over details. I will need to spend my time multitasking with the computer as I can only prove the quality of my care by checking boxes. Do not worry; studies have shown that physicians can’t multitask any better than anyone else and I will likely miss important details. In order to make up for that fact, I will order a bunch of unnecessary tests so I don’t miss anything.

Yes, I could probably figure out you don’t need half of them if we spent more time together, but I am told just talking to patients is poorly compensated care and I need to be mindful of this. I will rush out of the door onto my next patient who has been waiting over 30 minutes to see me to do the same to them.

You may call back because the problem we addressed has not resolved. Instead of thinking about your issue further, I will refer you on to a specialist because I am too exhausted to think. This is a much better use of resources, you see, because the specialist is trained to deal with very complicated and specific diseases. It is much better for them to see something that is straightforward and not use their training appropriately because that would require thinking and I have already shown you that thinking does not pay the bills.

You will see the very nice specialist I send you to and will feel reassured that they will know a lot about your health already because we have electronic records these days. However, I will forget to request to have your records sent over with your referral because I spent five hours on more important tasks such as typing, checking boxes and electronically filing paperwork; I am told only someone with 7 to 10 years of post collegiate training has the capability to do this. The specialist will not be able to see all your records because our systems do not communicate, but will receive something we call a problem list. However, she will miss part of your health history because it is buried in a list of 50 other very important diagnoses such as “pimple,” “cold,” or “administered vaccine.”

That detail will be important. You will not get better and will go to the ED. The ED physician will decide that he needs to hospitalize you after talking to you for two minutes, most of which he interrupts you to ask a question. Do not worry; the ED physician does this because he needs to see 50 patients in one hour. This is the patient-centered care you see advertised on billboards as 10 minute or less wait times.

You will have the opportunity to meet at least three more doctors while you are in the hospital. Do not expect them to be attentive or explain anything; they have been working for the last ten days in a row and can’t remember the details of your problem. When they write down the medications you should take when you go home, they will forget to include your water pill because they got 15 phone calls in 5 minutes.

You will likely gain 10 pounds because you didn’t restart your water pill when you get home. Do not worry; we are more efficient at providing quality care than ever before. There is now a 5-minute appointment awaiting you.

Susan Hecker is a physician.

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  • EmilyAnon

    “I will forget to request to have your records sent over with your referral because I spent five hours on more important tasks….”

    This is why I always request copies of my medical/hospital records so I will have them handy to take with me when I meet a new doctor. Many first appointments have been wasted because past records were never sent over as requested.

    Of course, whether that new doctor has the time to review those records is another story. Thus the possibility of redundant retesting.

  • Kristy Sokoloski

    Interesting to read this because a friend of mine that is from the UK told me that when she sees her GP she only gets to spend 5 minutes with them. However, it was interesting that she said even if she does go over that 5 minutes (which does happen sometimes) that the GP still gives her the time that she needs to have with the GP to take care of the problems for that visit. I was also reading something else that concerned me. It was from one of the nursing organizations in the UK that stated that legislation may get passed there to start naming the names of GPs publicly if they are GPs that don’t catch a cancer diagnosis as early as possible. When I read that it just gave me the creeps about what kind of problems that would create not only there, but here if something like that ever came to fruition. It was unbelievable to read.

    • DeceasedMD

      “When I read that it just gave me the creeps about what kind of problems that would create not only there, but here if something like that ever came to fruition.”

      Actually think about it. It’s already here. if any doc spends 12 minutes with a pt unless it is a very simple follow up, there is no time to accurately diagnose a complex set of problems and treat in 10 minutes.

      • Kristy Sokoloski

        yes, but I am talking about actual legislation like they want to do in the UK.

  • Kristy Sokoloski

    I had issues with my breasts back in 1998/1999, and the gyn I had at the time sent me for a mammogram. That was the first time I ever had a mammogram in my life. I was 26 years old. That mammogram was negative. Turned out that the problem I had that was thought to be in the breast was actually costochondritis. My mammogram in 2010 showed density which is normal for me. And my mammogram last year was normal. The reason that reading what I did gave me the creeps is because if they create some kind of a list like they are planning then almost every GP would be on that list. It would create shortages similar to like what is being seen here especially in certain parts of this country when it comes to having access to Primary Care. I am sorry about your friend and your step sister. I hope that both are doing ok in spite of it all.

    • Lisa

      Kristie, I think many of screening tests are way over used in the US. I don’t think annual exams are all that valuable. So I agree with you there. But I do think that some doctors ignore concerning symptoms or ignore family histories they should pay attention to.

      As I said to goonerdoc, the law really isn’t a good law, but I can see the motivation behind it.

      My step sister is fine now – several bad years behind her. And my friend is okay too, but she still can’t get the recommended testing.

  • goonerdoc

    Lisa- With all due respect, there are doctors that listen to their patients. There are doctors who really, really give 110% to their patients everyday. I’m sorry you haven’t met any so far in your medical journey. Right now, I’m totally freaking exhausted because I spent 12 hours in the clinic seeing patients, calling patients back, and addressing various other things, and I’m still waiting to hear from my radiologist about a stat MRI I needed to order at the end of the day, which added about another hour on to things. I don’t do this earn points with anyone or because I’m legislated to do so. I do it because I care about my patients and IT’S THE RIGHT THING TO DO. Please stop characterizing GP’s as not listening to patients. I’m not naive, and yes, there are some poor doctors out there, just like there are poor dentists, lawyers, teachers, janitors, etc. However, most of us really, really try our best. I really am sorry if you haven’t met them. I guess if you want to call me an idealist, so be it…..but patients are what I devoted a decade of my life to, and I feel really strongly about doing right by them.

    Anyway, thanks for listening. I know buzzkiller is shaking his head at me right now, but c’est la vie.

    • Lisa

      Well, I agree with you that there are good doctors out there and there bad doctors. I also think there are mediocre doctors. I’ve been treated by all three types of doctors. You sound like a good doctor.

      It is just that I get tired of hearing about doctors who don’t take symptoms seriously when they should. As I have a history of breast cancer, I hear and have talked to many young women whose diagnosis was delayed by a doctor who didn’t take a young woman’s lump seriously. it gets real old and sometimes you just want to shake your head and say there ought to be a law. I know legislation like Kristie mentioned is not good law, but I can see the motivation behind it.

    • HJ

      I have never had a “good” primary care physician. I have given up on ever finding one and have put my trust in Dr. Google and a few alternative care providers.,,

      • Eric Strong

        HJ, I’m sorry that you’ve yet to find a PCP who listens to you and who you trust, but trusting Dr. Google instead is really problematic. The majority of “medical” information available on the web is factually wrong. I agree with goonerdoc to “know your sources”, but how is a layperson going to know whether or not a source is credible? While it certainly happens that a patient’s internet research turns up info leading to a correct diagnosis missed by a rushed doctor, it’s more common for internet research to feed into hypochondriasis or to convince the patient to spend a fortune on ineffective natural/alternative remedies.

        • HJ

          I am not a hypochondriac…

          I am often treated like I am stupid by medical professionals even though I have been right more often than my doctors…

        • SarahJ89

          It’s not that hard. CDC, Mayo Clinic and other nationally known medical centers are pretty reliable. You read them all, cull out the outliers to get a consensus.

  • MightyCasey

    Rather than go all dystopian on everyone’s a**, why not think about teaming up with some of your savvier patients – you know, the ones who understand basic science, and their own bodies, and ask thoughtful questions during office visits – and working to pull down the walls of bullsh*t?

    If you’re trapped inside a massive practice, that will be more difficult, granted. However, just whinging about the sitch might make you feel better, but nothing will actually *change*.

    The most powerful coalition imaginable in the very broken medical-industrial complex is patients and clinicians, particularly MDs. How about we team up, start a real – and lasting – revolution?

    Just asking.

    • SarahJ89

      Good point. Actually, that’s what I like about this site–the conversation that builds bridges between doctors and patients. And some of us latter are pretty disgruntled, too. I’ve found it very helpful to hear what’s going on for doctors and to confirm my hunch that the broken system sucks for them to, just often in a different way than for us.

  • DeceasedMD

    What seems to be missing from a lot of these article types is pts being misdiagnosed. And anyone with a hard to diagnose or treat kind of illness is in real trouble. Common sense dictates that this can lead to increased morbidity and even mortality. That’s what we need to focus on.

    • SteveCaley

      I was shocked to see a website kvetch about a patient with undiagnosed hypercalcemia, which he suffered with for a YEAR. I’ve diagnosed it before. The high calcium is a hint, BTW. But the symptom set is interesting. He was in a nursing home for dementia, which went away when the hypercalcemia was surgically fixed.
      We are coming to an age where nobody will diagnose, just initiate the most obvious patch.
      Percocet works well for undiagnosed stomach pain. Another of my patients found that the pain simmered down after a week, but she still needed percocets. See, the pressure of the pus within her (fortunately) sequestered peritonitis, caused by her undiagnosed and untreated appendicitis, still caused her pain.
      This is in America. This represents America. Are we not proud of what that meant, once?

      • DeceasedMD

        Sad the nursing home pt did not have a proper dementia w/u before going to the nursing home. But will happen increasingly with our ever demented system that calls itself HC. good job.

        Wonderful examples of how our broken system just medicates away problems instead of diagnosing. No one pays for an MD to think. What does that say about our society? And as you say many are still proud. But of what?

        • SteveCaley

          Ah – that was one of our veterans. He had been hospitalized on the Acute side for, I recall, abdominal pain that did not show anything on the CT scan – just some constipation in an old fella with Alzheimer’s. They sent him to the Subacute Service, to get him ready for NH placement.
          “Really? I looked like I had ALZHEIMER’S? Wow!” was his comment, after his parathyroidectomy. He was neat, sharp and entirely fine after he went about life with a normal calcium.
          “Do the workup.” That’s all we’re expected to do. There is no perception that the workup is done to SHOW something – one merely executes it like the memorized dance steps at a formal ball. Nurses would come to me with the confident assurance – “So we did the EKG, …” The doing of the EKG, of course, is all that is necessary. The principle that it might tell you something of value, well, that’s not part of the job description.
          That’s why the machine minds are taking over medicine. If all one needs to know is the dance steps for “chronic abdominal pain,” why, that’s simple. What to DO about chronic abdominal pain – well, a laxative and nursing home placement sounds just fine, doesn’t it?

          • SarahJ89

            I’ve noticed the process of diagnosis seems to end with testing, not treatment. And yes, treatment by pill for symptoms without bothering to look under the hood is the norm now.

            It’s as if we’ve become intellectually bankrupt.

          • SteveCaley

            Worse. We have become deliberately indifferent, recklessly incurious, unmoved by human suffering. “Deliberate indifference” is a constitutional violation only in prison medicine. The incarcerated have a Constitutional right to more considerate treatment. For the rest of us schleppers, the system promises that someone will look at your arm. Someone will look at your arm.
            There is nothing more satisfying than catching a sly and hidden diagnosis, and treating it effectively. I do not hunt animals in the woods – but making a successful diagnosis that can help a patient – it makes me feel mighty, somehow. It’s warrior material.
            The hypercalcemia story is one – it saved a man years in a nursing home with a treatable dementia. I’m proud of that.
            There is nothing I feel more satisfied by than the fruits of professional productive empathy – not just feeling sorry for someone’s misfortune, but competently fixing it. How have we lost that joy of accomplishment in our culture? Where are our warriors?

          • SarahJ89

            I think many who would be warriors no longer know that’s even an option.I like the metaphor of diagnosis as hunting. I live in a hunting culture.

          • DeceasedMD

            so beautifully said. So sad the numbers are dwindling as to those that remember that. They feel more powerful doing a procedure-whether it is helpful or not.

    • SarahJ89

      Yes, yes, yes 1,000 times on the importance of the seemingly lost art of diagnosis.

  • doc99

    Apparently, life is imitating Lisa Kudrow’s “Web Therapy.”

  • Guest

    Perfect reason to move doctors onto salary – at group health cooperative most in person visits are from 30 to 40 minutes long using the medical home model

    • SarahJ89

      Really? It all got way, way worse in my area after the private practices were all bought up by the local “nonprofit” hospital. In this age of untrammeled greed it’s foolish to think begin salaried by a corporation will do anything but make things worse.

  • Sherry Reynolds

    If you live in a FFS world and the specialists are trying to keep their salaries up and profits intact for the hospitals and payers

    Perfect example of why we need to change our payment models ASAP.. At Places like Group Health Cooperative (over 620,000 members) many simple questions are deal with via email or the phone but in person visits are typically 30 to 40 minutes. They also had the highest provider and patient satisfaction scores as well as quality outcomes in the State of Washington and their Medicare plans are the highest ranked in the US..

    How do they do that? Doctors (both primary care and speciality) are on salary and they have docs lined up for the positions.

  • Sherry Reynolds

    Except for residency and internship in the US nearly all doctors work for the private sector actually.

  • DeceasedMD

    Appreciate your acknowledgement.It is a reality that we all know but is seldom expressed.

  • Lisa

    Except that many of the cases of doctors not listening that I hear about have nothing to do with the focus on efficiency of care. Rather it has to do with preconcieved notions on the part of the doctor, particularly in the case of young women with breast cancer, so they refuse to make the appropriate referrals as it can’t possibly be breast cancer. Efficiency or sloppy?

    • Patient Kit

      I have a friend whose GYN guaranteed her that her ovarian cyst was not cancer. Guaranteed her! In fact, he was so sure and so arrogant that he also told her that the only reason they were doing a biopsy was to confirm that he was right. Well, he was wrong. And when that doctor called my friend and told her on the phone that she, in fact, did have cancer, he did it in a jokey “good news, bad news” way that was way too much about his reaction to being wrong. My friend was totally blindsided by this doctor and completely unprepared to hear the news that she has cancer. I think part of this doctor’s reason for being so sure was his patient’s age. He thought she was too young for it to be cancer (She’s in her early 40s). I still get angry just thinking about this doctor and his cocksure guarantees. >:-(

      • Lisa

        Sigh . . .

        • Patient Kit

          Sighing with you. I don’t think my friend’s experience described above had anything to do with efficiency pressures. Thankfully, she has moved on and is in the hands of a different doctor now.

  • Nahum Kovalski

    Firstly, very few writers are effective in the use of sarcasm. I would humbly suggest that Dr. Hecker focus on her medical practice rather than a career in journalism.

    This is one of countless articles that relate to the present healthcare system in the United States as being from the worst I have ever heard of. From the tone of this article and many in the past, I assume that the medicine of old was superior because it allowed doctors to spend 30 to 40 minutes with each patient. Of course even a few decades ago, there was no CT or MRI or ultrasound or angiography or any of the advanced technologies that allow us to diagnose diseases that are also far better treated today than they were in the past. Despite the apparently horrid condition of American healthcare today, average lifespan is longer than it was a few decades ago. So somewhere, someone must be doing something right.

    I assume that Dr. Hecker and all those who identify with her, appreciate that the time and effort spent in writing such articles and then commenting on them, plays directly into the hands of the (evil) decision-makers. Quite simply, when all you do is complain, there is in fact no pressure to effect change. Without an alternative plan that is financially viable, the decision-makers will continue to enact new protocols and even legislation which may very well further negatively impact healthcare. If the present system is so dysfunctional, then use these forums to come up with alternatives that provide better care without increasing health care costs. You all may need to invest in the assistance of economists, business experts, financial planners and the like. But your endpoint should be a plan which presents inescapable logic in terms of how to both better medical care and even reduce healthcare costs. Any elected official will immediately support such a plan and push for it in all venues that they can. If all doctors approach all of their congressmen with such a plan, the likelihood that it will be enacted, is extremely high.

    My humble suggestion is to use what little time you have at the end of the day to play the same game as the decision-makers, and to make arguments that they will reluctantly have to agree with.

    • Susan Hecker

      Nahum, Thank you for offering your criticisms. I do not have any formal training in writing and certainly have a lot to learn.

      I also agree that we need to learn the perspective of all those involved in order to elicit effective change and focus our energies accordingly. Perhaps my article does just add to wasted noise and energy. I am hopeful that it will serve as a voice for both frustrated patients and providers alike, highlighting the commonalities we share instead of polarizing each and driving us further into our own silos. I agree that when both patients and providers are on the same team, change can occur.

    • Harpytalons

      You have obviously not been at the mercy of this system. She has it right. I am dealing with a very complicated medical condition right now. I’ve been to over 15 different doctors in many different specialities. Before the illness I worked in healthcare. I was in the trenches with these doctors and could see day after day the mounting frustration of not being able to care for their patients in the way that they believe is best. Bandaid healthcare, treat the symptoms but no one has time to look for the cause. All my MRIs, CTs, ultrasounds and routine blood work have come back normal, yet I’m still in so much pain that I can’t function. Was finally able to get in with a holistic doc but my insurance won’t cover it so I’m paying hundreds of dollars for his care. BUT he is trying to find the underlying cause so money well spent.
      Healthcare has become a business where there is a major focus on profit. Doctors are not the ones pushing for profit, it’s the CEOs and Washington.
      Doctors give up years of their lives between med school, residency and fellowship. They go hundreds of thousands of dollars in debt , they miss everything between their kids first steps to anniversaries to family vacations. Don’t criticize her for writing to inform in her down time. She could be spending time with her family or cracking a cold one with friends.

  • SarahJ89

    It actually has everything to do with money. No one cares about anyone’s freedom, the loss of it being merely collateral damage.

  • Suzi Q 38

    I don’t like a five minute appointment.
    If I don’t get to talk about what I need to talk about, I will give up and leave. On the other hand, I don’t need a 30 minute visit with my PCP each time.

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