Speed kills. Much is gained when the time on a heart-lung bypass is cut – to a point. Faster colonoscopies are not a good thing. We all know that speeding up the face time with a patient is not a good thing. Two new books discussed in an article in Tuesday’s Washington Post are written by physicians looking at how physicians practice and interact with patients. The article was written by Barron H. Lerner, a professor at Columbia University’s Mailman School of Public Health (I have a degree from there as it happens!)
Groopman’s work, some of which has been published previously in The New Yorker, argues that the way physicians go about diagnosis and decision making can frequently lead to missed diagnoses. Physicians are buffeted by competing forces – speed, to maximize patient flow and income, limit the use of diagnostic tools to patients who probably have what you are looking for, and to be able to predict which patients have the unusual absent any symptoms. I’ve written earlier about how the airline industry has worked to improve safety in great part by working on how cockpit crews work together to fly planes. There has been work done on patient interviewing techniques for physicians, some of which has been adopted within the Kaiser system.
I look to this kind of research and examination as a means of improving the efficiency AND effectiveness of office practice. All too many physicians – including one or two that I have seen personally – speed up the visit, speaking quickly and hurrying through the appointment. That’s not the answer – the answer is in developing techniques to get to issues of concern of the patient, identify and address matters that should concern the patient, and for the patient to leave with a plan of action that they will actually follow. At almost $2 trillion a year, we had better have a whole lot to show for the work which physicians do every day.