Have you bought a new memory foam mattress recently? Many come vacuumed in shrink bags. Once air gets in the bag, the mattress expands to its normal size. It is fascinating to watch how they expand.
It is not so fascinating to watch a patient expand to their actual size, when they are forcefully squeezed into an enclosed time space like an office appointment.
Patients are shrunk to fit a 15 minute slot on the schedule. It looks very tidy on paper. They are nicely organized in uniform slots until you rip off the bags and overflow happens.
15 min is short. It is sure enough for some, but for the more complex-than-average patient it is not. The latter is more of the norm in my practice, and probably yours as well.
Many times those “15 minutes” are followed by countless none-billable minutes spent on charting and paperwork after clinic hours that erode into time with loved ones, exercise, hobbies and much needed rest.
Assume for a moment that doctors are supposed to be the embodiment of sacrifice. Self-sacrifice for the sake of a patient’s well-being would sure be in line with that calling. What hurts, however, is the unnecessary suffering we have to go through that in the end does not benefit anyone.
This particularly plagues primary care, where high volumes are needed factory-style to make economical sense in the current reimbursement system. The system doesn’t do justice to us, dedicated physicians and other providers who idealize relationship-based, personalized medicine. Nor does it do justice to patients who need primary care the most, and are not in the office for a new job physical, for a cold or urinary tract infection.
We should start valuing quality primary care for what it is worth. For how it empowers patients to make the right changes, how it prevents unnecessary urgent care or emergency department visits, hospitalizations, referrals and diagnostics, but also how it allows doctors to live up to their calling without undue suffering.
Is direct primary care the answer? Maybe.
As far as I know, you cannot reconcile quality care and “shrink-bagged” patients.