Beat the Clock
Time is the one thing you can't create. And that's a touchy subject with most physicians, who complain they're spending more and more time making phone calls and filling out forms when they should be diagnosing disease and talking to patients.
"What's happened with managed care is that you just can't spend the time that's required with your patients or you go bankrupt," says Dr. Michael Gallops, a family practitioner in Naples. "[Doctors are] having to see six to eight patients an hour just to break even."
New insurance requirements are taking their toll, forcing doctors who want to maintain a certain income level to reevaluate the way they practice. Thanks to changes in fees and reimbursements, doctors now must see more patients a day to make the same amount of money.
It was enough to force Gallops out of the managed care business altogether. He now runs a boutique practice in which, for an annual fee and minimal additional fees for office visits, patients get comprehensive medical care with a highly personalized level of service unheard of with today's providers.
Back before the switch, it wasn't uncommon for Gallops to see 40 to 50 patients a day. Combine that with phone calls for lab work, and the number of patient contacts soared to 80 to 100 a day. "It was taking the fun out of medicine," he says.
And it's no fun for patients, either, who complain of over-scheduling and long waits for shorter examinations. And while at least one study has shown that the length of the average doctor visit has actually increased slightly, many patients insist they have less time with their doctors, a perception that may persist because so many outside issues influence the way physicians manage their practices.
"So many doctors are gatekeepers, meaning we're the paper-pushers for the insurance companies," says Gallops.
Many factors adversely impact medical care, from transient populations (which affect continuity of care) to ever-shifting HMO doctor pools and workplace insurance for younger people who change jobs more frequently. And while 15 to 20 years ago physicians essentially controlled all the information that found its way to patients, today patients are getting their information from an increasing variety of outside sources-primary among them, television and the Web. Direct-to-consumer advertising more than tripled from 1996 to 2001, rising from $800 million to $2.7 billion, according to researchers at the Harvard School of Public Health, Massachusetts Institute of Technology and Harvard Medical School.
"The problem is, every drug has its side effects and every patient is different," says Dr. Richard Kravitz, founder and medical director of Naples Healthcare Associates. "It's one thing to see an ad on TV; it's another to really know about the drug. It's a dilemma."
And so, along with all the other things that weigh on their time, doctors must act as a filter for misinformation. The hope is that most people are intelligent enough to filter out the garbage.
"You find mountains and mountains of information on the Web that may or may not be relevant or accurate," says Dr. Piedad Silva, a pediatrician in Fort Myers. "It raises the worry of parents, and we have to calm them down and make sure they have the right information."
But many doctors are learning to use the Web to their advantage. Instead of passing out potentially outdated brochures, many direct patients to any number of medical Web sites that are continuously updated.
Another time drain involves government legislation that is drastically changing the way doctors treat their patients. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was intended to ensure the privacy of patients and the security of their medical information. In some ways it works, discouraging pharmaceutical companies from sending follow-up mailings to patients without proper authorization from patient and doctor.
"The intentions were good," says Gallops. "But I think it's gone awry."
HIPAA requires physicians to maintain administrative, technical and physical safeguards that limit the release of a patient's medical information-even to attending doctors. Violations can lead to draconian financial penalties. And the American Medical Association reports that in some cases, physicians have been unable to check on patients transferred to another hospital.
"If I'm calling to talk to you about your wife's mammogram, that's illegal," Gallops says.
Or say your husband is being treated for diabetes but hasn't been to his doctor since last April. Forget calling to check his last cholesterol levels. They won't give them to you until he comes in and signs an authorization form. Patients are flooded with such paperwork.
Larger practices have the benefit of support personnel so doctors can focus on their job. But some physicians in smaller practices are forced to document visits on laptop computers while patients are still in the room, which can also detract from the doctor/patient relationship.
"Unfortunately, that seems to be where medicine is going. [It's] put an extra burden on the physician to hire more help," says Kravitz. "It increases the overhead that much more."
And while technology is beginning to catch up, allowing doctors to limit the paperwork load, it's not quite there yet.
"There's still plenty of paper," Kravitz says.
Talking to your Doctor
n Rank your concerns. That way, you can address the most important ones first. If a patient isn't assertive, the physician will take control of the agenda, so get your issues on the table immediately.
n Keep a checklist. Detail all medications, dosages and when you take them. List past surgeries and drug allergies. This saves time when filling out new patient forms and can prevent potential drug interactions for those on multiple medications for different ailments.
n Take notes. And be sure to write down your questions beforehand.
n Be honest. "Doctors make decisions based on honesty," says Gallops.
n Do your homework. Always check the background of a provider. That research should extend to whatever treatments they suggest.
n Ask to extend the time of your appointment. Some doctors might balk, but you'll never know unless you ask.
Web Sites Doctors Trust
Is there really such a thing as too much information when it comes to your own health? Apparently, yes. Factual errors, dubious claims and flat-out lies are rampant in cyberspace-to the point where it's making doctors' jobs even more difficult. Not surprisingly, there are only a few Web sites most of them will recommend, including these:
n Food & Drug Administration
n National Institutes of Health
n American Medical Association
n Mayo Clinic
n American Association of