Monday, August 4, 2014

The 15 minute visit to the Doctor's Office

Medical problems can be complex. They have the potential of altering our lives completely and for good and even the power of terminating life. Physicians have devoted a huge proportion of their lives to understand medical issues and to learn the art of palliate if not cure disease. 

Ideally, we should visit a doctor for prevention, advise end general education regarding health problems. The duration of the visit should be determined by the nature of the problem and by the complexity of the tools needed to solve it. Nowadays, in most settings, it is almost impossible to do that. Physicians watch the clock, not because they want to leave and go home, but because there is another patient waiting. And after that patient, there is another and another. All of them can carry problems of similar complexity. Is it fair to squeeze the 13 years of training that a specialist has (not counting the many years of experience after that) into 15 minutes of patient talk? 

An office visit, has the following elements: conversation with the doctor, physical exam, analysis of laboratory values, another conversation to report the physician’s ideas, prescription of medications, ordering further tests, documentation of the encounter and in many occasions, an interaction with the insurance companies to seek approval for certain medications or tests. Is it possible that a good job could be accomplished in 15 minutes?, in 30 minutes? 

This is one of the reasons why the doctor’s office has become a revolving door of patients who come for a prescription refill from a doctor who struggles to keep the practice afloat due to low insurance reimbursements. This is the reason why many complex problems remain unanswered, this the reason why diagnosis can take longer to be achieved and the reason why so many unnecessary  tests are ordered. This is one of the reason of polypharmacy, medication side effects and medication errors.

What can be done? Nothings substitutes good professional advice. This is why, in order to have a question properly answered, the internet should not be used. It should only serve to seek for a good physician. Second medical opinions provided by doctors that devote the proper amount of time to the medical problems are an invaluable tool that will help not only the person looking for the answer, but also the primary care physician who initially did not have the right amount of time to deal with the issue.

Originally posted in the Second Medical Opinions Blog on 7/29/2014

Friday, July 11, 2014

Why a Second Medical Opinion?

The doctor-patient encounter has traditionally been a strict relationship between a physician and the patient requesting the services. However, there were always concerns regarding the cost of the services and how accessible the services were. Starting some decades ago, insurance companies (private and government owned) started to participate in the relationship in an effort to make it more efficient. This had the consequence of spreading the risk and making healthcare more available to people. 

As time passed, healthcare became more dependent on the wellbeing of the insurance programs or companies. In order to be able to provide for all enrollees, the reimbursements to the providers started to decrease and, as a consequence of that, the time that the providers give to the patients also started to decrease (because they had to see more patients in less time so as to pay for overheads and remain profitable.) 

The natural result of this is that people remain with more unanswered questions and more doubts regarding their conditions or diseases. In this current world of gigantic leaps in the development of pharmaceuticals, surgical techniques, gene therapy, amongst others, the explanations that professionals (primary care providers and specialists) need to give their patients are complex. Many patients try to enhance their knowledge by using the internet. This is risky. The internet is filled with unreviewed information posted by un-credentialed people who might confuse or even misguide the patient who needs more answers.

A second medical opinion is a tool that will enable patients to be better informed, to be more reassured regarding their conditions and to bring up the possibility of more educated and effective communication with their doctors. For complex problems, two minds are better than one.

Marco A. Ramos MD

Published originally on the Second Medical Opinions blog on June 10, 2014