12 Minutes: A Day in the Life of a PCP
Posted by Beth Austin
I once again had the pleasure of hearing Erik Steele, D.O., speak at the Maine Health Management Coalition's recent payment reform symposium. His presentation: Health Care Costs....A Provider Perspective offered the audience "a taste" of his life as a primary care physician. He walked us through the phone calls he might receive in a day (ranging from a potentially suicidal teen to a patient vacationing in Las Vegas looking for a refill on a methadone prescription), a challenging patient case (an incidental finding of a lung nodule on an abdominal CT Scan), and a typical office visit (with a diabetic patient with high cholesterol). A key message of his presentation was that he does not get compensated appropriately - if at all - for many of the complex and critical tasks he will complete on this ordinary day. However, the point that most resonated with me was something he included in his opening remarks:
"I have 12 minutes to do whatever it is I have to do with patients. If you remember nothing else today, remember this."
Hmmm. On many days, it takes me 12 minutes to figure out what to have for lunch, which is hardly a life and death decision. (I mean, the mayonnaise would have to have seriously passed.) To play that out further and think of all the decisions I make in a day, I can't even fathom making them all in 12-minute increments, and yet, Dr. Steele needs to make choices that can have a substantial impact on the quality of his patients' lives in this small window of time. Also, as it turns out, he is being generous when he says he has 12 minutes. Remember the typical office visit I mentioned earlier with the patient who has diabetes and high cholesterol? When he gives us the play-by-play of how he spends the 12 minutes with this patient with multiple chronic health conditions, we disccover that only about eight minutes is spent actually talking about the patient's health issues, goals, or treatment.
In all the scuttlebutt surrounding healthcare reform in recent months, we've been able to distract ourselves with semantics and questions of constitutionality and avoided the fundamental yet critical topics surrounding care delivery. The overall health of Americans is abysmal. To improve this, we need a healthcare system that builds and reinforces constructive and trusting provider-patient relationships. These relationships are a cornerstone to educating and engaging patients, improving adherence, and effecting positive behavior change. How is Dr. Steele going to do all that in 12 minutes? I'm left wondering how long it will take for more than just a relative handful of people to have real conversations about how to give providers the time and resources they need to help patients manage and improve their health.