10 Minutes to Think

The bean counters of medical establishments have figured out how to keep our doctors busy

By Joni Halpern

Take a good look at your doctors the next time you go to see them.  They don’t have time to do more than glance at you, so you can give them a good going over while they engage in cyber-course with computerized algorithms that now dictate every moment of their working life.

You’ll notice a growing number of your doctors look tired; they have bags under their eyes, regardless of their age.  They look as if they could trade places with you on the examining table and sleep for a week.

Often their skin is sagging.  Many of them are putting on a few pounds – the ones they advise us to take off.  You may find yourself wondering how your doctors could put on weight while running from one examining room to the next.

Of course, the medical establishment that employs them urges them to use their lunch break to get some exercise.  But if they step out for a walk, they get behind in their emails, patient notes, and reports.  As a result, they receive warnings and queries from the medical software program about why they did not meet their required number of revenue-producing interactions with patients.

Watch as your doctors race through irrelevant questions the computer software forces them to ask.  You come in for migraines.  The computer requires questions about colonoscopies, vaccinations, and past ailments you may have already attempted to erase or correct in your computerized chart.  Although your doctors may acknowledge these items are irrelevant to the present complaint, they have no choice but to ask them, eating up precious minutes they could have used to ask you about the problem at hand.

Your doctors may hand you surveys the government forces them to provide.  While you busy yourself answering a barrage of questions that have nothing to do with your present concerns, your doctors race to see patients waiting in the next examining room who are sitting on the table, looking at the wall charts, wondering whether they should get dressed.

On your doctors’ faces, you may see frozen images of strain, fatigue, and even despair.  You may try to crack the ice by telling them how much you appreciate what they do for all the patients who come to them.  You may tell them you know how hard they work, how they have given up so much to become well-trained.  But be careful.  They are not used to being appreciated.  It sometimes makes them fight back tears.

If you’re lucky, your doctors may have time to examine you, maybe even converse with you.  But not for long.  They only get about 10 minutes, sometimes less, to complete all tasks for a regular visit, including answering all the computer questions and inputting all new information.  If they ever get 15 minutes, they feel like a racehorse out for a stroll.  Sometimes they have people who write things in the computer for them.  But that doesn’t mean the doctor gets more time with you.

Doctors who have practiced for many years think of their profession as an art that improves with experience and advances in technology.  But a great portion of the art – and the satisfaction that comes from practicing the art – only arises in a relationship in which trust allows the doctor to unearth sensitive, relevant information from patients who would otherwise be reticent to share or perhaps would not think certain essential facts were important.  It takes time to build trust in any relationship, and nowhere is it more valuable than when it is needed to assist in the diagnosis and treatment of a person’s illness.

Having time to think is also important, for it helps doctors pull together their own knowledge and experience, their patient’s information and experience, and the results of technology, all of which become the foundation of better medical outcomes.  Having time to think also allows doctors to feel they are engaged in the interesting and challenging job of identifying cause, effect, and treatment.

But time spent ruminating is not a billable event, so today’s doctors can’t do that on the clock.  Instead, they are tethered to the schedule like Gulliver , with dozens of protocols that maximize billing, filling doctors’ time only with actions that can be monetized.

Take a good look at your doctors.  What you see in large part are intelligent, well-trained human beings who once wanted to serve others, be respected, improve their expertise through experience and exposure to new ideas and technology, and make a decent living.  This may be what they wanted.  It is not what they have.

Today, your doctors are factory workers.  Many of them toil in the health care equivalent of the old Ford factories, where workers were pushed to the limit of production line output.  Were it not for the preeminence of revenue as a goal in every portion of our society, we should not find it necessary to remind ourselves that the medical profession should be different, because human beings are not like Model-Ts.  We are healed in part by the trust we place in our doctors, and in fact, they are nourished by it as well.

It is a theft of the public treasure to rob doctors of the time they need to develop a relationship with patients, think about a case, consult with colleagues, research, teach, or otherwise engage in the full breadth and depth of a profession that has been at the forefront of our advancement as a society.  And that theft is costing us in the growing number of well-trained, experienced physicians who are leaving the field before a normal age of retirement.  It is also costing us in the loss of well-qualified young people who are avoiding the profession in search of more gratifying and appreciated ways of making a living.

Take a good look at your doctor the next time you go in.  Think about what it means to give up your youth in order to excel in college, medical school, residency, fellowship, and all the other types of advanced training required in order for doctors to care for us.  Think what would make a person devote their life to medicine when it means that every day, they will encounter their fellow human beings when we are at our worst – smelly, soiled, bloody, hurting, out of our minds – waiting for them to relieve our discomfort in bodily spaces others would never have the courage to touch.

The bean counters of medical establishments have figured out how to keep our doctors busy enough that lunchtime is a luxury and time spent at home catching up on computer input is commonplace.  Sure, it costs a lot of money to run health care institutions, regardless of whether they are nonprofit or for-profit.

But if we allow our doctors to be forced into practice regimens that rob them of satisfaction and deprive them of emotional nourishment, we will lose them to other “factories” where the student debt is not as large and the professional responsibilities are not as demanding.

Maybe when we see our doctors, we should sit still and not say a word.  That would give them at least 10 minutes to think.