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M.D.s don’t have time to teach prevention
According to a Duke University study published in
a recent issue of the American Journal of Public
Health, medical doctors “don’t have time” to
provide patients with information or
recommendations on how to prevent health problems.
Such service would, the researchers estimate, take
an estimated 7.4 hours out of a primary care
physician's day, leaving approximately 30 minutes
for critical and chronic disease care.
“We know that prevention is very important for the
health of our nation,” said Kimberly Yarnall,
M.D., lead author of the study. “But what our
study showed was that given the large number of
recommendations -- everything from cancer
screening to lifestyle counseling -- coupled with
the large number of patients that most physicians
are responsible for, it is simply not possible for
physicians to deliver all those services to their
patients. It's a big problem.”
Dr. Yarnall said that the average patient in a
family practice waiting room needs 25 preventive
services that have been recommended by the U.S.
Preventive Services Task Force. Recommended
services vary depending on age, sex, chronic
disease status and gestation. Frequency of the
services also varies from patient to patient.
Using these recommendations, the researchers
assigned conservative time values to the tasks.
They estimated the average number of patients a
physician sees in a year to be 2,500 and used U.S.
Census figures to model a patient panel with an
age and sex distribution similar to that of the
U.S. population, including children. Chronic
disease statistics and pregnancy rates were also
factored into the model. The calculations
dramatically showed what Yarnall said doctors and
patients have been reporting for years: that there
is not enough time for all of the recommendations.
“Most would assume that the answer is to pare down
the recommendations,” said Yarnall, “but even if
we slashed the recommendations in half, it would
still take half of every day, or half of every
visit, to do half of what is now recommended.
Prevention is critical, particularly since chronic
disease rates in American adults and children are
on the rise.”
Yarnall also said that the problem will become
worse as baby boomers age and as new genetic tests
become available.
Lloyd Michener, M.D., senior author on the study
and chair of Duke University Medical Center’s
department of community and family medicine, said
that the solution to the problem of inadequate
time for preventive care lies in creating a new
health care model that uses a team of caregivers.
“By working together, we can offer the patient
better care,” said Michener. “When we relieve
physicians of the sole responsibility for
prevention, we can free them up to handle more
complicated disease management and acute care.
Patients will have more time to discuss complex
issues of care, while still receiving the quality
preventive care that they need.”
SOURCE: American Journal of
Public Health, April 2003.
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