Who Will Take Care of You?
A growing gap separates doctors and patients. The new healers are now stepping in to fill the void
So where did the time to build that relationship go? The average physician visit hasn't shrunk; from the late 1980s through the end of the 1990s, it has hovered between 16 and 22 minutes, depending on which survey you look at. But what's happening is that both doctors and patients are walking into that visit with new, expanded agendas, says Dana Safran, director of the Health Institute at Tufts-New England Medical Center and another researcher who monitors the doctor-patient pas de deux. "Patients have taken to heart the message to be informed and smart, and they are coming in with a lot more questions and a lot more of their own info that they've taken off the Internet and from other places," she says. "Doctors, for their part, have their own concerns." If they don't ask a lot of straight biomedical questions, insurance companies and healthcare oversight agencies will penalize them, making it harder to get paid. So while the office visit didn't get shorter, docs and patients need to say more than ever in that same tiny time frame.
Psychosocial ties. So something gets cut out. And what docs cut, says Levinson, are the psychosocial aspects of the visit. "They're not asking about patients' lives, about their communities, about anything that leads to continuity of care," Levinson says. "And these are exactly the questions that patients want to be asked and need to be asked. The biomedical and the psychosocial are so intertwined in primary care."
And that's why Todd Ringler sees Anne Krekis, his nurse practitioner. "I've been seeing her since 1992," he says. "She really knows me, and I have complete confidence in her and her clinical ability. For instance, I used to be a social smoker, you know, out in a bar. Anne and I had a discussion about it, about the risks to my health and to my family--I have kids--and I never had that kind of talk with a doctor. I've had to switch health plans, or switch care centers in the same plan, and they tell me to get a new primary physician. And I say, 'Fine. Give me anyone. As long as they work with Anne.' She does my annual physical. She's who I call when I get sick. She really is my doctor."
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