Although they are spending more time with their patients, according to a new study published in the Archives of Internal Medicine, primary care doctors (whose income has decreased by 10% adjusted for inflation from 1995 to 2003) are not meeting quality measures.  Despite the perception, doctor visits have increased on average from 18 minutes in 1997 to 21 minutes in 2005.   But, the authors claim, this has not meant increases in quality of care.  They particularly harp on the amount of time MD’s spend counselling their patients on things like diet and exercise.  They do say patients are getting more appropriate meds for certain conditions (like beta blockers for people with coronary artery disease) - and that this does not necessarily take any more time (duh, writing for Metropolol vs HCTZ takes no more time).  In my opinion, this article focuses too much on this counselling stuff.  Of course we are supposed to counsel patients but lets face it, ultimately, it is the patient’s decision to get off their ass, stop smoking, eating McDonald’s, and get to the gym.   I think this sort of thing is better accomplished by dietitians and other ancillary staff.  The doctor should mention it, but does not need to spend 15 minutes telling the patient what sorts of whole grains to eat.  And just because more time was spent with a patient, does not mean that the doctor has more free time to spend with them.  I bet part of it is that the whole running a practise (filling out innumerable forms, fielding phone calls, doing diligent charting, etc) sucks up a lot more time. Perhaps they are documenting as they go (that is what my son’s pediatrician does on his little computer note tablet), and answering more questions (since everyone seems to be looking up medical stuff on the Internet), or practising more defensive medicine and that is why the visits are longer.  It all adds up to more work for less money regardless.  No wonder no one wants to go into primary care.

    In other ER -related news in the same journal, a  study published states that “One in four emergency department patients in 2006 waited longer to be evaluated by a clinician than recommended at triage, an increase from one in five in 1997“.  We all know that longer wait times cause all kinds of problems.  Patient dissatisfaction, delays in diagnosis and treatment, failure to meet quality measures, and increases the number of people who leave without being seen. Most upsetting, is that when they adjusted for severity of presenting complaint at triage (emergent, urgent, semi-urgent, and non-urgent), they found that the patients most like to NOT be seen within recommended times were the most emergent patients!  The non-urgent (med refills, stubbed toes, etc) were MORE likely to be seen within the recommended times!   Hmmmm. I have a theory.  At my hospital, we are judged by Press-Ganey surveys entirely on patients who are treated and released. Thus, we can spend an hour with a coding patient, save their life, and get no credit for it (from a patient satisfaction rating point of view)while the chronic Fibromyalgeur trashes us on their survey because it took so long to be seen ( and God forbid that we did not give them enough Dilaudid).  This overall kills our patient sat scores, putting us in the toilet compared to our peers who blasted through their fast track patients in no time (and in many cases, causing us to earn less bonus money at the end of the year).   Meanwhile, they may have a higher death rate of their sicker patients, but hey, that ain’t important  (cough, cough) after all!   It doesn’t take long to reaslise where to put the resources - more fast track so that people can come soon in a leave fast and happy.   If you ask me, this is just so wrong on every level.   I personally feel a lot better at the end of a shift when I have successfully brought someone back from the brink of death than if I managed to see 3.5 fast track patients per hour……