There is growing concern that physicians are spending less time with patients. One study at Johns Hopkins earlier this year documented that physicians in training are now spending about eight minutes per day with each of their hospitalized patients. The reasons are complex: Things that used to be done by doctors, such as drawing blood, are now done by non-physicians; restrictions on duty hours limit the amount of time trainees can spend in the hospital; and managing the electronic health record now consumes a great deal more physician time.
While the reductions in time for patient contact have been apparent for many years, some of their consequences are still just emerging. It is becoming increasing apparent that when speed is of the essence, patience, curiosity, and compassion can cease to be virtues. Instead they often become expensive liabilities that must be weeded out in the name of increased efficiency. What will medicine look like in the future? As products of this system, will today’s young physicians come to resemble customer care providers at the health care counter of the local department store?
The patient – call him Mr. Jones – was a middle aged man, successfully treated for cancer, which was now in remission. He returned for a routine follow up visit and was being seen by a fourth-year medical student, Joe. Joe’s mission was to perform a focused history and physical examination and review Mr. Jones’ laboratory and radiology results. After consulting with his attending physician, Dr. Smith, he would reassure Mr. Jones that everything was going well. The whole visit should not have taken more than 15 or 20 minutes.
Dr. Smith, who was busy seeing other patients, noticed that Joe was taking an unusually long time with Mr. Jones. What could he be doing? It was not uncommon for medical students to require more time than seasoned physicians – in fact, it is the norm. But in this case, the visit was dragging on far longer than expected, and it was beginning to push the clinic behind schedule. So Dr. Smith stopped by the exam room and poked his head in. At a glance, he could tell that Joe and Mr. Jones were engaged in a deep conversation. In fact, Mr. Jones had tears in his eyes.
Dr. Smith asked Joe if he could speak with him privately for a moment. “What is happening with Mr. Jones? Is there a problem?” Joe reported that toward the end of their session, Mr. Jones had posed what seemed to be an innocent question. “Tell me doctor, these medicines you prescribe – do they sometimes stop working?” Joe knew that for a variety of reasons medications could lose their effectiveness, and he said as much to Mr. Jones, thinking that would be the end of it. But then he began to wonder, why had Mr. Jones posed such a question?
His curiosity piqued, Joe posed a follow up question. “Do you have some particular medication in mind?” After some hesitation, Mr. Jones admitted that he did. The medication he was referring to was an antidepressant. This led to further questions, and Joe soon realized that Mr. Jones was depressed and contemplating suicide. In fact, he had even made plans to threaten a police officer, so that he would die without the stigma of taking his own life. Just a month before, he had attempted to kill himself by overdosing with another medication.