Introduction

Reviews

Is Your Doctor Taking Enough Time to Do the Job Right?

Timothy B. McCall, M.D.

Since doctors have little financial incentive to spend time with you and in many instances are actually penalized for it, the amount of time a doctor spends interviewing you, examining you and explaining things reflects how genuinely concerned that doctor is for your welfare. Luckily, you can directly observe how much time your doctor devotes to these activities.

The interview and exam are where doctors collect most of the data important to good medical care. The less carefully they collect this data, the less accurate their predictions will be about what you have, what tests you’ll need and what treatments should be tried. Doctors who cut corners during the interview and physical exam may order the wrong tests because they weren't looking in the right place. They may also order more tests than would have otherwise been necessary to rule out diagnoses that could have been eliminated—more safely and inexpensively—by the interview and exam.

For some medical problems the interview alone is enough to make a diagnosis or at least to rule out certain possibilities. Migraine headaches are so classic in their symptoms that a careful history may be the only thing needed to make the diagnosis. At other times, as with the heart-pain of angina, the interview can help decide whether or not further testing is warranted.

How important is the interview in making the correct diagnosis? Researchers at West Virginia University studied the relative contribution of the interview, the physical exam and laboratory tests in 80 patients who came to a medical clinic with previously undiagnosed conditions. They found that after just the interview, the doctors could make the diagnosis 76% of the time. The physical exam resulted in another 12% of the patients being diagnosed. Lab tests resulted in another 11% of the diagnoses.

But in order to conduct an adequate medical interview, the doctor must devote sufficient time to it. Doctors who spend a few rushed minutes with you, ask a series of rapid-fire questions, glance at their watch and scurry out of the room are unlikely to provide first-rate care. The may neglect to obtain vital bits of information leading them to miss diagnoses, order the wrong tests or prescribe the wrong drugs. You probably won't end up feeling very good about the encounter either.

Skimping on patient education also undermines the quality of the medical care. Patients with a poor understanding of their medical conditions are less likely to follow a doctor’s instructions, make suggested lifestyle changes, take prescribed medicines and recognize side effects of therapy. They are also less likely to feel satisfied with their medical care.

Some doctors fail to spend enough time with patients out of financial considerations, while others may simply be victims of their own success. These in-demand doctors are so overcommitted and spread so thin that they can’t do any of their patients justice. Other doctors, like the harried interns of teaching hospitals, have long working hours imposed on them.

Whatever the reason, doctors who don’t spend enough time with their patients can’t deliver first rate care—no matter how much they know or how good their credentials are.

Next: How Well Does Your Doctor Prescribe Drugs?