Decisions in the Examining Room

Most doctors are doing their best to see patients in a timely fashion, and address at least their most urgent medical needs. But they usually seem to be in a rush, without enough time to sit and hear details of the patient’s concerns. The Insurance-Centered medical system only pays for a few minutes of Primary Care Physician time, and imposes mandates on additional tasks that the doctor must complete in that brief encounter. Since the doctor is not allowed time to have a detailed discussion of the patient's symptoms, a proper diagnosis cannot be established at that time. So instead, the doctor orders tests or referrals, then moves on to the next waiting patient.

The press and politicians accuse doctors of ordering tests to generate more income for themselves. As in any field, a relative few do abuse the system, and that greedy minority should be censured and disciplined. But they certainly do not account for the outrageous costs of our healthcare system.

Rather, it is a systems problem. The doctor wants to diagnose the patient's symptom, but does not have time during this visit, so instead sends that patient for testing and/or specialist consultation. Each negative test simply means it was not the correct test to diagnose the symptom, so additional tests are ordered, invoking further expense and delay. And if the specialist finds that the symptom is not caused by the organ system of their expertise, they forward the patient on to a different specialist.

We all work for the person who writes our paycheck. While the doctor intends to help the patient, in our current Insurance-Centered system the third-party payor is writing checks, and therefore writing the rules.  The insurance company’s needs are met, but the patient is frequently frustrated by long delays in diagnosis, and endurance of tests and procedures that are frequently fruitless. Unnecessary expenses have gone through the roof.

The solution is to make the physician responsible directly to the Patient, rather than a third-party. In a Patient-Centered structure where the patient writes the check, the physician’s primary responsibility is to meet the Patient's needs, even if that account draws on pooled healthcare funds. If the empowered consumer is not satisfied, he/she switches to another provider.

In Patient-Centered medicine the PCPs incentive is to meet the patient's needs and diagnose the symptom.  The experienced PCP knows the best and quickest way to diagnose the symptom is to ask detailed questions and listen to the patient -- they tell us what is wrong, if we take the time to listen!