Are Shorter Doctors' Visits Just a Myth?.
How is it possible that such widely received wisdom can be stood on its head?
Mechanic, who says he himself initially accepted the conventional wisdom, believes the popular media is a culprit, peddling anecdotes about managed care horror stories based on isolated patient experiences without objective confirmation.
In fact, he says, objective data reveal great variability among managed care companies. "We get fixated on anecdotally built theories that divert us from the really important policy issues of access to health insurance, appropriate ways of organizing long-term and chronic care, and quality of care," he says.
And Mechanic suggests that because of the backlash against managed care, many managed care organizations are increasingly focused on patient satisfaction. "Doctors know that a key to patient satisfaction is the time they spend with them," he says.
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."