"There’s no CPT code for contemplation. But extra time dedicated to thinking—with either longer patient visits or protected time for 'panel management'—could actually be remarkably efficient. We would save money by reducing unnecessary tests and cop-out referrals. We’d make fewer diagnostic errors and avert harms from overtesting. And allowing doctors to practice medicine at the upper end of our professional standard would make a substantial dent in the demoralization of physicians today." —Dr. Danielle Ofri
Dr. Danielle Ofri is a faculty member of NYU School of Medicine and a physician at Bellevue Hospital, the oldest public hospital in country. Her recent post, Perchance To Think, is an indictment of the healthcare system that has failed both its patients and its providers.
It's a critical read that uncovers the reality many providers face— one which ultimately jeopardizes patient care and creates untold amounts of waste.
But more than that, it's a reality driven by an industry buzzword: efficiency.
Imagine for a moment (and it shouldn't be difficult), you're a patient sitting in an exam room. Suddenly, a provider comes sweeping in. You're surprised by the sudden movement after waiting alone for what seemed like a long time. And you think, "The doctor must be running late."
You wouldn't be too far off—the provider's laundry list of tasks would send any patient's mind whirling. It starts with seeing around 30 patients a day. And that doesn't include the paperwork, the transcriptions, the requests, and the phone calls.
After a brief handshake, you notice the provider's eyes moving fast, looking through a list of details you assume is about you.
After a few nods and a couple of questions, the provider flies out the door, handing you a slip of paper with directions to go to the front desk to schedule whatever it is you need to do next.
It all happened so fast, you're not even sure you remember the provider's name.
It's not you. You're not crazy. It's "efficiency." And it's killing our providers and our health system. Efficiency isn't the right solution when what providers really need is more time to:
Think and analyze a patient's situation and history
Ask questions to build trust and rapport with patients
Connect the dots between symptoms
Find a solution and develop an effective plan for treatment
Why? Because at the end of the day, providers are paid to move patients through the system, dole out prescriptions, and move along through their endless list of names they don't even recognize. Not to mention hoping they don't uncover something unusual or "atypical" that will force them to stop and think for a moment.
Providers are doing all they can to provide great care, but they aren't being paid to slow down and think. The result is wasted time and wasted resources. But this is also the source of:
We believe so. This is especially true when primary care is the central hub for a patient's entire health journey.
When primary care is done right, it's loaded with time. It sees trust, relationships, and behavior change as the path to health instead of settling for the treatment of symptoms. That means:
Digging into deeper questions
Inviting meaningful, helpful dialogue
Active, empathetic listening
It’s the only way to get to the root issues of our health. When patients feel heard, they feel relief and peace. That allows them to consider taking responsibility for their own health and changing their behavior.