Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What rushed patient encounters are doing to patients and physicians

Hisla Bates, MD
Physician
November 5, 2019
6K Shares
Share
Tweet
Share

Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments while they rush through patient encounters.

During a lunch break at a recent health care conference, Dr. Michaels*, an internist, shared her story. Dr. Michaels worked for a major academic hospital, where she was required to see 14-16 patients a day.

When she didn’t meet her productivity requirements, her salary decreased by 7 percent. For two consecutive years, her wages drop by 14 percent, forcing her to leave the practice and feeling depleted and unappreciated. As a result, she gained 100 pounds and developed hypertension due to stress. According to Dr. Michaels, the hospital made no effort to retain her, despite her 27 years of dedicated service, further leaving her feeling diminished.

Dr. Simonson* was seated on my right; he was just two years out of his family medicine residency and working in a concierge practice. The first words out of his mouth were, “I love my job!” He noted that the most important thing for him was the “human connection and the ability to spend more time with patients.” Concierge practices have been springing up all over the country, and they offer patients more direct care for either an annual fee or a monthly membership fee. Doctors tend to see fewer patients per day and are well compensated.

“I am so thrilled to hear you love your job.”

“Yes, thank you for saying that.”

“There are too many unhappy doctors these days,” I added.

He nodded in agreement.

“In my experience as a patient and a physician, doctors feel rushed, and they don’t do complete physical exams or take much of a history. When I was in my medical training, we were taught to do a complete physical exam from head to toe on every patient, with a thorough history and review of systems.”

“Oh, we don’t do that anymore; it is all about risk management and assessing for safety. We don’t do complete physical exams. That’s old-school,” he chuckled.

Dr. Simonson told me he conducted an initial history and physical assessments in 40 minutes. In my mind, that was not enough time. If you don’t examine your patient’s entire body, you could miss something significant, like enlarged lymph nodes or a melanoma, I thought to myself.

Dr. Pamela Wible, MD, a physician advocate, and speaker, who has made it her mission to inspire doctors to start what she calls “micro-practices.”

A micro-practice can be established with minimal overhead, allowing doctors to see fewer patients and spend more time with them. She encourages doctors who have been on the verge of leaving medicine, who are suicidal or depressed, to work for themselves and exit the big-box clinics and hospitals.

She has helped hundreds of doctors bring creativity and innovation to their work by encouraging them to be the change they want to see in medicine. In Dr. Wible’s vision, the relationship is between the doctor and the patient is sacred and should be nurtured. In micro-practices, there is no need for additional staff.

I often wonder why we need so many ancillary staff in doctor’s offices? There are nurse practitioners (NP) and physician’s assistants (PA) who practically function as doctors, with fewer years of training. It has been my experience as a patient, the NPs and PAs do the preliminary work for the doctors, take the initial history and do the physical exams, only to have the doctor or surgeon come into the room and nod he or she agrees. As a result, the doctor spends less time with the patient. When scribes are present to assist the physician with documentation, patients may not be as forthcoming with a non-clinician in the room, and it may impede the doctor-patient relationship.

Daniele Ofri, MD, author of What Doctors Feel: How Emotions Affect the Practice of Medicine, noted the rate of severe diabetic complications was 40 percent lower in patients whose doctors scored high on empathy. She stated a factor such as empathy, had similar benefits to those seen with intensive medical therapy for diabetes.” Doctors aren’t compensated for listening to their patients. If they spend too much time with patients, they are seen as inefficient or slow. Medicine today has missed the power of empathy in healing.

When I go to the physician, I, too, have noticed that there is minimal touch by the doctor. Physical exams are sometimes superficial. Hands are frequently gloved, and instruments are often a barrier between the physician and patient. The invention of the stethoscope created distance between the physician and patient. Now with the enormous dependence on technology and more of a reliance on imaging and laboratory data, touch and physical exams have lessened and at times, are nonexistent.

What I love about being a physician is putting the patient’s story together piece by piece. I consider myself a detective of sorts. The joy in medicine and the benefits of being a physician are lost if we are only medicating and chasing symptoms without looking at cause and prevention.

If we as physicians feel that we are just going through the motions every day, checking boxes, meeting productivity requirements, checking labs, we bound to fall short of our calling with diminished empathy for the people who need us most, our patients. It is the human connection that brings us joy in our work and lessens the burden of burnout. Let’s all find a way to be the change we would like to see.

* The names of the physicians were changed to protect their identity.

Hisla Bates is a psychiatrist.

Image credit: Shutterstock.com

Prev

The doctors guide to making a good real estate offer

November 4, 2019 Kevin 0
…
Next

Letting go when people let go of their lives

November 5, 2019 Kevin 0
…

Tagged as: Primary Care

Post navigation

< Previous Post
The doctors guide to making a good real estate offer
Next Post >
Letting go when people let go of their lives

More by Hisla Bates, MD

  • When a trauma surgeon is sick and afraid to die

    Hisla Bates, MD
  • Health care workers are precious jewels. Treat them as such.

    Hisla Bates, MD
  • Burnout in fashion and medicine: A fashion designer turned physician compares notes

    Hisla Bates, MD

Related Posts

  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • The complex expectations of patients toward their physicians

    Michael L. Millenson
  • Physicians and patients must work together to improve health care

    Michele Luckenbaugh
  • Let’s order a round of respect: for both patients and physicians

    R. Lynn Barnett
  • Physicians are trapped between patient satisfaction and unnecessary prescribing

    Richard Young, MD
  • A patient’s open letter to aspiring physicians

    David Penner

More in Physician

  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • The dark side of medicine: an urgent call to action against greed

    Don Gaede, MD
  • Dr. Glaucomflecken for president!

    Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast
    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Abortion Is Not Murder in the Eyes of the Law
  • Introducing Allergenic Foods Early Tied to a Reduction in Later Allergies
  • Isotretinoin REMS Still Needed, But Its Burden Could Be Reduced, FDA Staff Says
  • Children Do Well With Fewer Opiates After Surgery
  • High Out-of-Pocket Costs Tied to Less Follow-Up After Initial Mammography

Meeting Coverage

  • Children Do Well With Fewer Opiates After Surgery
  • Advances in Diagnosis and Management of Severe Cutaneous Adverse Reactions
  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • New Combinations Promising in Advanced Urothelial Carcinoma
  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • The psychoanalytic hammer: lessons in listening and patient-centered care

      Greg Smith, MD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Surviving clinical rounds: tips and tales from a pediatric hematologist-oncologist [PODCAST]

      The Podcast by KevinMD | Podcast
    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...