Sunday, June 07, 2009

If All Doctors Had More Time To Listen

From today's New York Times:
LILI SACKS, a primary care doctor in Seattle, says she began thinking differently about her work on the day she realized she was beginning each appointment with the words, “Sorry I’m late.”

Scheduled to see as many as 25 patients a day at a large clinic, she lacked the time for thorough examinations and discussions. Because of this, she said, primary care doctors are often forced to order tests and send patients to specialists.

“Could I have helped some people without specialists and tests? Absolutely,” said Dr. Sacks. “Would it have saved the patient and the insurance company both money? Absolutely. Is the system set up for the best care and cost efficiency? Absolutely not.”

Dr. Sacks said she worried that seeing so many patients would lead to errors. Last year, she moved to a clinic that focuses on longer patient appointments, 30 to 60 minutes. This translates to 10 to 12 patients a day. Patients also communicate directly with her by phone or e-mail.

I am reading a book right now called The Tipping Point by Malcolm Gladwell which talks about what factors are involved in causing trends to change, whether that trend is an epidemic, fashion, crime. In it he describes a study that is relevant to today's practice of medicine.

Two Princeton psychologists, John Darley and Daniel Batson, did a study where they asked theology students to prepare a talk on a Biblical theme and then walk to another building to give the talk. They were not told that along the way they would pass by a man slumped over in an alley with his eyes closed and groaning. They wanted to see what factors would increase the likelihood that the theology students would stop to help the man, and in effect emulate the parable of the"Good Samaritan".

What determined whether these otherwise caring and conscientious students would stop and help was not their desire to help others, how recently they were reminded of the Good Samaritan parable or even whether they were about to give a talk about the Good Samaritan. What made the difference was how much time they had. If they were told that they were running late, only 10 percent stopped to help. If they were told that they had a few minutes to spare, 63 percent of the students stopped to help.

From The Tipping Point:
What this study is suggesting, in other words, is that the convictions of your heart and the actual contents of your thoughts are less important, in the end, in guiding your actions than the immediate context of your behavior. The words, "Oh, you're late" had the effect of making someone who was ordinarily compassionate into someone who was indifferent to suffering -- of turning someone, in that particular moment, into a different person.

So I don't blame doctors who are harried and rushed to see 20+ patients a day if they are less thorough or even less caring. The current dysfunctional healthcare system will harden even the kindest hearts.

But more and more doctors are choosing a different path, the same one that I chose 5 years ago. One that allows for more time to listen, to think, and to do what we have been trained to do. For a directory of where to find like-minded doctors, go to the IMP Map.

If all doctors (or even just primary care doctors) had more time to listen, then we would have better healthcare. The question is, will the new healthcare reform that is shaping up in Washington give us that time?