Ran into a radiology colleague today. He will retire soon, and was happy to discuss the stress on radiology. I have observed more interpretation errors (or at least I think I have) over the past five years. We now strongly stress that the learners review all films and question radiology reads.
My friend opined that volume expectations have become unsustainable. We order too many imaging studies. When you ask physicians to ramp up the volume, they make errors. As he described volume expectations and the impact on his field, I immediately categorized his laments as the same laments we hear in primary care and hospital medicine.
An underlying principle that insurers and policy experts do not understand frames the issue. You hurt patients when physicians cut corners. The predictable implication of excess volume is that physicians must cut corners.
Some patients require a 30-minute visit, yet administrators tell their physicians that they must average 15-minute visits. Radiology errors occur when the radiologist does not have the proper amount of time to spend carefully examining each film. The same concept occurs for virtually all subspecialties.
Physicians generally have pure intentions. We want to help our patients. How can we help each patients properly if we do not provide the appropriate attention to their problems? We should spend enough time talking with the patients and examining them. We should spend enough time making certain that they understand their disease processes and prevention strategies. There are no shortcuts. We must spend time researching their problems when they are less usual. We should be able to communicate with patients while they are in the office, but also on the phone and through electronic means. These all take time.
Our profession has great complexity, a complexity that payment formulas do not recognize. Each patient deserves our attention and enough time.
We need more well-trained physicians. We need physicians to care for a reasonable number of patients. This is a patient issue, but it is also a physician issue. We face a major burnout problem in medicine. One reason for burnout is a personal sense that we are not devoting enough time to each patient. That dissonance between our personal expectations and outside pressures leads to great discomfort.
Patients are suffering while physicians are suffering. In what world does this make sense?
Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.
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