In a MEDSCAPE story I read this morning, I found this: “15-Minute Visits Take Toll on Doctor-Patient Relationship.”  Well: no duh!!

When did things head south?  “No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare’s 1992 adoption of a byzantine formula that relies on “relative value units,” or RVUs, to calculate doctors’ fees,” writes Roni Caryn Rabin, the author of this story.

By the way, the reality is that many doctors have had to lower that vaunted headlined “15 minute appointment”  down to just 7 minutes to “break even” because of (a) declining reimbursements, and (b) steadily increasing overhead expenses. There are numerous citations to this effect, and also stories of doctors quitting the profession when it got to the point that they could only do a 7 minute visit.

We don’t do “15 minute appointments” at CWI unless it’s an established patient, with no complications, being seen only for a “med check.” And these appointments are rare.

This sorry state of current affairs has come to be because of the following:
– politicians promising to provide more “free medical care” or “Affordable Care” – hmmm, where have I heard that before? – than they can deliver in order to get votes;
– insurance companies (and state and government “payors”) cutting reimbursements so they can make money (or not lose any more);
– doctors who got into the profession for the purpose of helping people being led like little meek sheep to the slaughter;
– patients who have so far tolerated this sorry state of affairs.

There is a limit, however, to how much both patients and physicians will take. I predict when the only way to do medicine is a 2 – 3 minute visit with the doctor and patient, there will be demands for reform. Mistakes will be made – (no one is that good to be able to be an astute diagnostician in an average of 3 minutes with a complicated history to deal with) – and patients will die; more physicians will burn out and quit or suicide (a growing trend). Fewer bright young men and women will go into medicine, and there will be a radically reduced and totally inadequate number to deal with the medical issues of the future.

Speaking of which….
XXX Antibiotic-Resistance-01

(“A cluster of methicillin-resistant Staphylococcus aureus bacteria. MRSA can cause skin infections, bloodstream infections and pneumonia and is one of the drug-resistant infections raising alarm around the world, according to a new report from the World Health Organization.(Photo: U.S. Centers for Disease Control and Prevention” – quoted and used from today’s USA Today)

Now there are more challenges to the medical system: a growing number of “superbugs” that are becoming resistant to ALL antibiotics. Steve Solomon, a director of a CDC office dealing with this issue, was quoted in today’s (5/1/2014) USA Today as saying this: “The threat is tremendous. We are truly threatened with failing off the edge of this cliff into the post-antibiotic era.”

Let’s see these issues be addressed in a 3-5, 7, or 15 minute (pick your number) appointment.

But – on the bright side: there’s never been a better time to practice medicine for the networked, technologically savvy doctors who tap into the world’s “hive mind” of medical research and information than there is today.   We may be facing superbugs now, but we’ve cracked the human genome, personalized genetic treatments are now available for certain cancers, research in antibiotics continues. In functional medicine, there has never been the data that we now have to established principles of foundational physiological optimization for virtually all the body systems.  In psychiatry, we’ve never had the precision in drugs and treatments, including TMS (Transcranial magnetic stimulation).  In neurosurgery, we’ve never had the Gamma Knife until the last couple of decades.

For those that can survive the system (and hopefully work towards a better one), we can all be comforted by the world of William J. Mayo, MD (“Dr. Will”): “The glory of medicine is that it is always moving forward, that there is always more to learn.”