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Keywords: Participatory medicine, physician-patient communication, quality of care, shared decision making, patient portal, EMR, electronic medical record.
Citation: Smith CW. Never enough time for patient care — what can we do? J Participat Med. 2012 Mar 7; 4:e5.
Published: March 7, 2012.
Competing Interests: The author has declared that no competing interests exist.

My fellow Editor-in-Chief Joe Graedon reminded me recently that doctors and patients spend an average of about seven minutes together during an office visit. The pressure is relentless, and patients must queue up for just a few minutes with their doctor. They often leave with more questions than answers, and the result is just bad care. Too few patients receive appropriate, evidence-based care for conditions like diabetes, hypertension, and hypercholesterolemia. Healthy patients who simply need good preventive counseling and screening seldom get ideal care, either. To a great extent, this is because of time constraints.

What is the answer? First, we should maximize the time we have together. Both the patient and the physician can prioritize their tasks for the visit. Patients can help by jotting down two or three key questions that they need answered. They can also help by limiting their issues and questions during the visit to the top priorities. The physician can review the medical record prior to the visit, suggest to the nurse those tests or procedures that need to be done today, and quickly review the most recent office visit, thinking about what issues need to be revisited today.

After the visit is when participatory medicine really begins to kick in and change things. Since there is not enough time to give and receive good care in the approximately seven minutes we have at the office, we agree that one or more of the following will happen between visits:

  • A care plan will be followed, a copy of which is shared with the patient as she leaves the room;
  • Her test results will be available on the “patient portal” within three days, together with a letter from me, outlining any actions needed as a result of the test results;
  • She agrees to email me with any questions or concerns that arise between visits.

It turns out that the patient has a question about her lab results. We exchange emails which address the question. As a result, we decide she needs to begin a medication. I open the electronic medical record and send the prescription electronically to the pharmacy.

She experiences side effects from the medication (which she realizes as a result of a Google search and review of a health information website) and decides she needs to come in earlier than scheduled to discuss this. She logs onto the portal and makes an appointment — I see her in the office the next day. The cycle continues.

This is the “tip of the iceberg” of participatory medicine. The patient is actively engaged, communicating through methods that don’t require office visits unless they are absolutely necessary. We are saving money, communicating efficiently, tweaking issues as the need arises. The result is more satisfying, more effective, lower-cost care that has the potential to change the game of health care in America!

Copyright: © 2012 Charles W. Smith. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.