Doctor Time With Patients

So we do have problems with our health care system, but some things aren’t bad.  For example, we apparently get a lot more time with our doctors than patients do in most countries, according to new research in the British Medical Journal.   (BMJ Article)   The authors did a literature survey around the world for studies on how much time primary care physicians spend with patients.  They found 179 articles  covering 67 countries.  The researchers not only looked at consultation length, but also for associations with various factors, like per capita health care spending, and with certain outcomes.  The range across the 67 countries was from 48 seconds in Bangladesh to 22.5 minutes in Sweden.  The US clocks in second at about 21 minutes.  Yea, we are near the top in some international health care measure!!  Many of the most populous countries, like China and India, are near the bottom.  Only 16 countries had average visits of 15 minutes or more.  In Australia, the UK and the US, visit length has shown slight increases in the last few years.  Visit lengths were longer in countries with higher health spending, as you would expect, even after adjusting for purchasing power parity.  Visit lengths also were associated with a greater number of physicians per population unit, as you would also anticipate.  Surprisingly, there was no relationship between visit length and total number of consultations per patient per year.

The importance of the research relates to both the quality of patient care and patient and provider satisfaction.  Physicians report greater dissatisfaction with their jobs if they don’t have adequate time to spend with patients and a leading source of patient unhappiness with care is feeling that they don’t get enough time with or attention from their primary care physician.  This meta-review confirms those associations with visit length.  And not having enough time may compromise a physician’s ability to understand the patient’s health needs or coordinate care.  This review found some support for that, in terms of potentially avoidable hospitalizations for diabetes, but found little impact on ER rates.  The purpose of a visit may affect length, for example in many countries a doctor has to see a patient to refill a prescription.  That can be avoided in the US.  Other cultural factors regarding the role of the doctor, or patient expectations, may also affect visit length and satisfaction with that length.  Physician extenders, like nurses, can make up for some of the loss of time with a physician, but if you are counting on primary care doctors to manage a patient’s health, they probably need more than 5 or 10 minutes for a consultation.