With one eye on the clock and the other on the patient, a doctor hopes the patient will stick to the chief complaint and not bring out a “laundry list” of their health concerns. Predictably, the 15 minute norm for patient consults can quickly turn into a “struggle for control” over the allocation of time, says Dr. Richard J. Baron, president of the American Board of Internal Medicine (Kaiser Health News, April 21, 2014).
“The patient is thinking: ‘I’m taking the afternoon off work for this appointment. I’ve waited three months for it. I’ve got a list of things to discuss.’ The doctor is thinking: ‘I’ve got 15 minutes.’ There is almost a built-in tension,” says Dr. Alex Lickerman of the University of Chicago.
How did the 15 minute consult become the norm? No one really knows, although it probably goes back to 1992 and Medicare’s adoption of a complex formula that changed the way it paid doctors. Up until that time, Medicare had reimbursed doctors based on so-called “usual and customary fees.” The “new” formula-determined method relied on “relative value units” (RVUs). “The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15 minute consult,” according to Roni Cary Rabin of Kaiser Health News. Private insurers soon changed their fee schedule to be consistent with the Medicare formula. “To avoid income cuts, doctors had to see more patients–instead of doing three an hour, they did four,” according to Princeton health economist Uwe Reinhardt. The impact has been especially hard on primary care physicians since they don’t generate revenue from procedures like colonoscopies and biopsies.
One of the most important elements of doctoring is making the patient feel they have been heard, says Dr. Lickerman. “People feel dissatisfied when they don’t get a chance to say what they have to say,” he said. “I will sometimes boast that I can make people feel they ‘got their money’s worth’ in five minutes. it’s not the actual time or lack of time people are complaining about–it’s how that time felt.”
