My Sept. 15th and 19th posts were prompted by a story about not taking time to determine which patients are, indeed, allergic to penicillin. I want to explore the problem of time, not only as it relates to doing the right thing in medicine.
It takes time to practice expert, compassionate care. If the patient's situation is straightforward and all goes smoothly, doctors need time to...
- Take a thorough history from the patient
- Think through the differential diagnosis (the list of possible explanations)
- Think through the best tests to order (and in what order to order them)
- Deal with insurers that require precertification for tests or procedures
- Prescribe the tests, especially if communicating clinical information with the requisition
- Review the test results in the context of the patient's situation
- Explain the results, conclusions and recommendations with the patient
- Answer the patient's questions and other needs
- Prescribe therapies
- See the patient in follow-up
- Deal with all paperwork of documentation and insurance filing
Of course, often the patient's situation is not straightforward and things don't go smoothly. The screening tests may not provide the final diagnosis. The best therapy may cause side effects or other problems, or it may not work to resolve the condition for which it was prescribed.
Everything can be going well medically, but the patient may need further explanation or encouragement to continue with recommended tests or treatments. It takes time for the doctor to understand what the hang-up is and how best to help.
[P.S. Sorry I've been posting so infrequently lately. Just finished writing a new book. And had lots of keynotes to polish and deliver. All is well.]