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Frazzled Physicians Strapped for Time

So preventive health care suffers, study finds

THURSDAY, March 27, 2003 (HealthDayNews) -- Doctors often complain they don't have enough time to do all they need to do for their patients.

A new study says they're right.

If primary-care physicians performed all the preventive health services recommended for their patients in an average office visit, they'd only have about five minutes left to treat acute medical problems, according to research that appears in the April issue of American Journal of Public Health.

Procedures such as taking blood pressure, doing breast exams, giving immunization shots and counseling about diet, smoking and exercise are all essential to good preventive care. But without help, it's impossible for doctors to follow these procedures and still take good care of their patients, the study says.

"This is the first study that estimates the amount of time required to deliver preventive health care, and what we found was that there isn't enough time to do it," says Dr. Kimberly S.H. Yarnall, a Duke University Medical Center professor and lead author of the study.

Physicians have been saying for years that they don't have enough time to treat their patients optimally, Yarnall says, even though time spent in doctors' offices has increased slightly in the past decade.

"I myself have been frustrated. A patient would leave and I would know I hadn't done what I could have," she says. "I'd ask myself, 'Why can't I be more efficient?'"

"But we found it really is a time issue," she adds. "There is more work to be done that can be done during an average visit."

Dr. Stephen Schoenbaum, senior vice president of The Commonwealth Fund, a national foundation that supports research to improve health-care practices, says the information provided in this study is overdue.

"We don't have a lot of data about the most effective ways to practice ambulatory medicine," Schoenbaum says, "and this study opens up the discussion to find efficient ways to deliver effective preventive care."

For the study, the Duke scientists researched the estimated time it takes to perform 25 preventive health services recommended by the U.S. Preventive Services Task Force (USPSTF).

These checks include screening for disease, counseling for lifestyle habits, and immunizations. Then the researchers, using data from the American Association of Family Physicians, found that primary-care doctors see an average of 2,500 patients annually, for an average of 45 minutes each.

When adjusted for a daily work schedule, these numbers translated into 7.4 hours a day that doctors would have to provide preventive services, leaving about 30 minutes to treat medical problems. Per patient, this means that 36 to 40 minutes of each visit would be taken up with preventive care, with only about five minutes left for more acute care.

"That is when a patient says his arm hurts, or he has a stomachache," Yarnall says, and the doctor should examine the patient and treat a possible medical problem.

In the study, Yarnall and her colleagues recommend that physicians work with non-physician clinicians so that patients can get the care they need.

"The new model we propose is to stratify care," Yarnall says. "Use physicians for what they do best, which is more acute care, and use nurse practitioners and physician assistants and nutritionists to deliver counseling, PAP smears and dietary counseling. A patient would have a team of health-care providers who take care of them."

More information

For help in making up your own checklist for preventive health tests according to your age, gender and health, visit the Palo Alto Medical Foundation. For additional information, check with the Agency for Health Care Policy and Research.

SOURCES: Kimberly S.H. Yarnell, M.D., associate clinical professor, Department of Community and Family Medicine, Duke University Medical Center, Durham, N.C.; Stephen C. Schoenbaum, M.D., senior vice president, The Commonwealth Fund, New York City; April 2003 American Journal of Public Health
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