Friday, June 15, 2007

Time With A Patient



My good friend and once med school roommate had a letter published in today's New York Times. Quoted in full:


Re “A Stubborn Case of Spending on Cancer Care” (Business Day, June
12):


Despite recognition of the problem, the fact remains that our current
system of health care reimbursement values procedures and volume over time spent with patients.


The time spent talking with patients and families is an
investment that pays for itself many times over. Carefully eliciting a history,
reviewing records and communicating with other health providers, assessing
patients’ values and weighing them into decisions regarding complex treatment
options cannot be done in 10 minutes, but it can provide better and more humane
outcomes.



Technologically advanced and costly treatments save lives, but
their allocation needs to be made sensibly and not to the detriment of
old-fashioned talking and listening between doctor and patient.



Patients want and deserve this time-intensive care, and although it
can often be ultimately cost-saving, it will not be the norm until the financial
incentives reverse themselves.



Susan C. Kalish, M.D. Boston, June 12, 2007



I have a nice friend, she is a warm and caring doctor with an enormous heart and wonderful values, even if she isn't a psychiatrist (she's a geriatrician). Sometimes I'm not sure exactly what medicine is about--we allocate our resources in idiosyncratic ways, some of which don't make sense in terms of cost-benefit but do in terms of emotion. We've come to see physicians as precious resources, whose time needs to be meted out in cost effective 10-minute doses while the humanity of medicine is doled out to less expensive professionals-- nurses, physician assistants, social worker therapists. Susan says, and I'll agree, it's a mistake.