Are Shorter Doctors' Visits Just a Myth?
Shorter Office Visits
Edward W. Campion, MD, deputy editor of The New England
Journal, who authored an editorial accompanying the study, believes the
increasing number of doctors is a crucial element. "There has been a 21%
increase in the number of physicians per capita," he tells WebMD. "That
has to have an effect."
He also believes that the increasing complexity of medicine,
and the number of informed patients who come to an office visit with questions
about complicated topics, has driven up the time doctors spend with patients.
"The study is an example of how useful it is to get objective data rather
than relying on intuitions that can be misleading," he says.
Others suggest caution in interpreting the data. Jerome
Kassirer, MD, professor of medicine at Tufts University School of Medicine,
points out that the survey did not take into account the age of patients. While
physicians may be spending more time with older, sicker patients -- and thereby
increasing the overall average time spent -- they may be spending substantially
less time with younger patients, Kassirer suggests.
"We know older people take more time, and there are more
older patients," says Kassirer, who is also associate research scientist at
Yale University School of Medicine and editor-in-chief emeritus of The New
England Journal of Medicine. "What we may be seeing is an artifact of
the aging population."
Kassirer also notes that the busiest doctors may not have
participated in the survey. He also points out that it is not possible to
independently verify the record keeping for patient visits, which may be done
by assistants and secretaries.
"Managed care organizations are looking for doctors who
will spend time with patients regardless of the restrictions, and so assistants
or secretaries may be keeping track of time differently than they did in the
past," he tells WebMD.
Neither Mechanic nor Campion believes the frustrations
expressed by doctors and patients with managed care are completely fabricated.
While the actual number of minutes a patient can spend with a doctor may be
increasing, continuity of care over time may have deteriorated, resulting in a
loss of trust that feeds misperceptions, they say.
"Trust between a patient and a doctor is built iteratively
across visits," Mechanic tells WebMD. "That is why continuity of care
is so important."
According to Campion, patient perceptions of a doctor visit can
be influenced by a variety of factors. "If you are hassled and under
pressure, that is not going to seem like a comfortable visit," he says.
"The quality of a visit can be affected by how long a patient has to wait.
If a patient has to wait 90 minutes, it is going to be an unsatisfactory visit
no matter what."