A Matter of Time

I received many interesting responses to my recent column about whether longer visits might actually be more beneficial and cost-effective--not to mention more satisfying for both doctor and patient.

A dermatologist wrote to say that he insisted on spending a half-hour with each patient--very unusual in his specialty--accepting the loss of income that this practice incurred. He wondered if physicians were being creative enough in finding ways to spend more time with patients, even if that involves earning a lower salary. Unfortunately, in many practices, that's not an option--a physician needs to see so many patients per year to keep his or her position.

A teacher, a therapist, and a businessman each commented that slowing down and being more present, whether dealing with a student, client, or colleague, builds stronger relationships and nets better results--no matter what the goal.

Several people asked whether shorter and longer medical visits and have been compared head to head in a clinical trial. They haven't, to my knowledge.

One reader pointed out something that I've noticed in my own practice: extra time spent getting to know a patient saves time (and, probably money) later when an urgent issue arises. If the clinician understands a particular patient's preferences, fears, support system (or lack thereof), etc. and a patient feels comfortable with the clinician, it's amazing how much faster they can get to the bottom of that mysterious fatigue, nausea, or headache.

Finally, one hospital administrator noted that we seem to be trending away rather than towards the "slow medicine" I described. She worried that as we move into ever larger medical "systems," such as Atul Gawande discussed in a provocative New Yorker essay comparing medical practice with the Cheesecake Factory, visits will become even shorter.

I'm worried, too.