More signs that doctors are beginning to see patients as consumers

This old NYT article (from August 20th, 2005) titled "Sick and Scared, and Waiting, Waiting, Waiting" delivers yet more evidence that more doctors & staff are waking up to the reality of consumer-led market pressures and hurrying to make the best of it.

The article addresses in particular the common patient complaint of waiting to see a doctor.

Waiting has long been part of medicine. Patients like Ms. Odlum wait for test results; others spend weeks or months waiting for appointments or stranded for hours in doctors' waiting rooms.

But health care researchers say the waiting problem has only gotten worse. Advances in technology have created more tests and procedures to wait for, and new drugs and treatments mean more people need more doctor visits. Doctors' appointments for people over 45 increased by more than 20 percent in the last decade, according to the National Center for Health Statistics. Emergency room visits increased by 23 percent, although the number of hospitals declined by 15 percent.

Some doctors say they doublebook appointments to make up for patient cancellations. And doctors say they are pulled in so many directions that, in many cases, long waits are unavoidable.

"There is nothing magic about waiting," said Dr. Charles K. Francis, president of the American College of Physicians.

"Most of us have patients in the hospital and patients in the office," Dr. Francis said. "Then the patient has to go to the lab, and medicine is unpredictable."

He added that insurance companies reimbursed doctors at lower rates than in the past, resulting in intense pressure to see large numbers of patients. "You have to work long hours and see more patients just to keep your office open," he said.

It seems market forces, in this case dictated by insurance companies, was one reason waiting time has increased. Another is more advanced technology and better diagnositic tools and therapies. The article then addresses how market forces from consumers are compelling doctors in the other direction.

Recently, however, patients, some doctors and researchers have begun to ask why medicine cannot be as accountable to its customers as any other business. And some doctors' offices and hospitals are starting to solve their waiting problems by applying techniques that businesses use.

Dr. Philip Greenland, chairman of the department of preventive medicine at the University of Michigan, woke up to the frustration of waiting when he was seeking care for his mother broke her hip and he was unable to see doctors in a reasonable amount of time.

"What was shocking about this experience to me is that it's almost the only time in my life since I've become a doctor 35 years ago that I ever experienced medicine directly, from the patient's point of view," he said. "What this tells me is that the profession has lost sight of what medicine is all about. It's not about them. It's not about their schedule. It's about the patient."

He added: "Doctors are not victims here. If they are unable to handle the workload, they need more help. If it means inconvenience, they have to live with it."

Another physician suffered burnout from the problems generated by the practice of medicine that was generating the waiting problem for patients. Instead of using slowly changing aspects of his practice, he did something drastic. "He quit his three-doctor practice and started a new one.
'I started with one room, an exam table and no employees, just me,' he said. Instead of having about 2,000 patients, he cut back to 500. Not only did he get rid of waiting times, but, by getting rid of most of his office and all of his staff, he eliminated his overhead, making his practice affordable."

Oddly, the article ends rather cynically (perhaps realistically).

But few doctors are ready for such a solution. Most, Dr. Murray says, tell him, "Waiting times are not bad, waiting times are acceptable."

That attitude, he noted, is part of the culture of medicine.

"It grows out of that insularity that we get to decide who waits and who doesn't," Dr. Murray said.