March 5, 1996 in Nation/World

Doctors’ Patient Loads Soar Hmos Pressure Physicians To Spend Less Time Per Patient

Boston Globe

If you’re feeling rushed in the doctor’s office, join the crowd. Prodded by health care managers, physicians are trying to squeeze more patients into every hour, to the point where many worry that care is being seriously shortchanged.

“Doctors appear to be under a lot of stress,” said Carlton Anderson, 63. “Whatever you have to say to them, you’d better get it out right away because they have so many other patients.”

Anderson’s complaint is notable because his primary physician is Dr. Sheldon Greenfield, a leading authority on the drive to streamline medical practice and how it affects patients. Greenfield acknowledges that he is not immune to the pressures on doctors across the nation to be more “productive.”

“The other day a patient asked a sensitive personal question at the end of his visit, and I could feel the tension in me,” Greenfield said. “He wanted to discuss it with me, but I couldn’t do it. The clock was ticking.”

Like an increasing number of doctors, Greenfield and his colleagues were recently told to meet a “productivity target” that holds new patients to 40 minutes for a first visit and others to 20-minute visits.

This is actually on the liberal side of such targets. “At the University of Pittsburgh, their internist volume targets are 15 minutes per patient,” Greenfield reports. “That’s a big comedown. They’re used to spending 30 minutes.” In some managed care systems doctors are expected to cram a patient encounter into 10 or even eight minutes.

“Eight minutes is not a workable time. It’s ridiculous. But some groups and some health plans expect that,” said Dr. Barbara Stewart of Boston.

Research by Sherrie H. Kaplan, Greenfield and their colleagues at New England Medical Center indicates that 20 minutes is about the minimum needed for a productive doctor-patient encounter.

The most effective care, Kaplan and her coworkers believe, is “participatory,” meaning that the doctor presents treatment options, discusses pros and cons, elicits patient preferences, and with the patient reaches agreement on a treatment plan.

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