Medical Megatrends and the Future of Medicine blogger Dr. Schimpff writes that a lack of listening is the core problem in American healthcare. It’s part of a series of blog posts he’s writing on the crisis in primary care.
There is and will be a need for many more primary care physicians (PCPs). Why is this the case? For one, there’s already an identified shortage. And it’s going to be exacerbated by at least four reasons.
1.) The population is growing.
We are not like Europe, where at a time, certain countries had negative population growth.
2.) The population is aging.
Yes, the baby boomers are retiring.
3.) More individuals will carry healthcare coverage as a result of the Affordable Care Act.
It’s estimated that our nation will need at least 52,000 more primary care physicians in 2025 as proposed recently in the Annals of Family Medicine.
4.) More PCPs will care for a reasonable number of patients, ~600 – 1000 (depending on demographics) rather than today’s common 2500+.
Doctors get burnt out seeing 24-25 or more patients per day in their offices. In many cases they quit. The fact remains: the need for PCPs will increase.
This last factor is a particularly important reason driving a need for more PCPs. With fewer patients seen per day, the PCP can then spend the time needed to listen, to prevent, to coordinate and to think – four key activities that they often are not able to do effectively today.
This will drive a need for substantially more PCPs.
However, the solution isn’t going to be graduating more TOTAL medical students. Instead, we need to make primary care desirable as a medical professional career. This is where Direct Care comes in. This means overcoming the current non-sustainable business model that burns current doctors out and dissuades graduates from the field. Compare that with our business. It’s sustainable, and it makes our docs a good living.
Seriously, our patients send us donuts because they value our service so much.
In the fee-for-service world of group hospitals, patients are lucky if they’re seeing the same doctor every time, and that that doctor can remember their face and their name.
There’ value in primary care physicians taking time to thoroughly listen to a patient and assess the situation. In one case, Dr. Schimpff tells of a PCP who saw a lady he’d known for years. She was always enthusiastic and articulate. When she came in one day for a routine visit, though, the PCP noticed that her speech patterns were slightly different than he recalled. It was barely perceptible; if you didn’t know her well you wouldn’t have recognized the change. When asked she said she felt fine.
The changes were subtle but they were perceptible. Her medical history wasn’t remarkable; nothing raised a red flag for the PCP. He ran a neurologic exam and that too was unremarkable. Something was amiss, though.
Finally, he ordered a brain MRI. Her insurance company refused to cover it because she had no specific indications as to the necessity of the test. The PCP had to call multiple times and explain his rationale until the insurer would agree to cover the test.
The MRI showed a primary brain lymphoma – treatable, probably curable.
In this case, the PCP knew his patient. And he had the benefit of an extended visit time. That’s why he noticed the subtle changes in her speech pattern. His skill combined with these circumstances probably saved her life.
Compare that experience to the following story.
A woman took her mother to the cardiologist recently.
He spent a fair amount of time with the patient, listening, trying to figure out her medical issue.
When he thought he’d determined the problem and the solution (which happily, did not involve a drug or surgery but behavior modification), he said he’d call her internist and explain the situation. Her mother had been seeing this person for many years, but she waved her hand dismissively and said, “He doesn’t know me.” The cardiologist was surprised but the woman understood. Her mother was saying that her internist had not spent time listening to her and getting to know her unique situation like this cardiologist had done.
Her mother started following the cardiologists and continued doing so. His unhurried gentle questioning, sympathetic listening and obvious desire to figure out how to help her is what earned her trust.
Yes, it’s awesome that the cardiologist listened to her mother and developed a plan of action — for her and her daughter to follow. The most unfortunate part is that she felt her PCP (that she had visited for many years) didn’t know her, because he didn’t listen.
It’s clearcut: When doctors do not have enough time to listen the result is that they do not listen.
A study from 1984 of primary care physicians observed throughout patient visits revealed the following:
- Doctor interrupted the patient within 18 seconds on average.
- In only 17 (23%) of the 74 visits was the patient provided the opportunity to complete his or her opening statement of concerns.
- In 51 (69%) of the visits, the physician interrupted the patient’s statement and directed questions toward a specific concern.
- In only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement.
This lack of listening is the core care problem in American healthcare today, writes Schimpff. It is not getting better. It is the inadequate income per patient (effects of crippling red tape) that is driving the lack of listening. Today the average PCP sees too many patients for too little time. They pay into the red tape, they pay into the insurance companies, they pay into the drug companies, and they get burnt out doing so. They tell students to stay out of the practice.
Meanwhile, our nation contends with staggering rates of obesity, diabetes, heart disease… all phenomenon that could be prevented by doctors who are given time to listen, and who can make their ears readily available.