Tuesday, December 04, 2012
It's Open Access Time!
The new policy at NIH is that all publications resulting from NIH funding have to be posted to a repository called PubMed Central for open access after one year. Here's one of mine, that went live today.
Many people -- both doctors and patients -- complain that there isn't enough time in a standard medical visit. In order to make their boat payments, doctors typically average 12 to 15 minutes for regular outpatient visits. In fact, there isn't much evidence that visits used to be a lot longer, but medicine, and life, have gotten more complicated, and that amount of time seems less adequate than it used to. Of course a higher percentage of patients are older and sicker than in the past, and of those who are sick, there's usually more to be done. In addition, we're managing diagnoses that didn't used to exist - "pre-diabetes," high LDL, and so on.
The people in our study all had HIV, and they were visiting HIV specialists, but for these patients, as for most people with HIV, the HIV doc is also their primary care doc. Most of them were doing reasonably well, so these visits, on average, weren't a whole lot longer than 15 minutes. But, they varied a lot. Using a coding method of my devising, we found that longer visits tended to appear to be more "patient-centered" -- less physician verbal dominance (i.e., doctors normally talk more than patients but it was more even in longer visits), more patient questions, more patient expressive utterances, that sort of thing.
As you will often find with me, there's a "but" -- when we looked directly at the really long visits, many of them seemed more patient centered because a lot of what went on wasn't really medicine. In one, the patient spent most of the time griping about his siblings who were squabbling with him over his mother's estate. In another, the doctor spent several minutes teaching the patient about the history of South Africa. In another, the doctor tried to recruit the patient to go to church with her.
So it's not that simple. We're there on business. Most of us expect efficiency and likely value quality over quantity when it comes to interacting with our doctors. In fact, my own mother happened to volunteer to me the other day that she really appreciates how her ophthalmologist concentrates on business and doesn't get into a lot of chit chat. She adores him, but it's because she trusts him to take care of her eye (she only has one), not because he's all up in her stuff. That makes sense to me.