One more thing: The increasing number of recommendations on prevention

Physicians face an ever-growing list of preventive health screening questions to ask. These questions add to medicine's time pressures, but do they bring value to the exam room?

By Kathleen Phalen Tomaselli, AMNews correspondent. Jan. 23, 2006.

It's the Wednesday after Hurricane Katrina in New Orleans. The sick and injured continue to flow in and out of a 10-bed critical care tent, and the task of treating them is daunting. Thirty-three patients an hour for 12 hours.

"In a 12-hour shift we saw 400 patients. We treated, stabilized and transferred," says Maurice A. Ramirez, DO, a Kissimmee, Fla., emergency physician who also works for the Dept. of Homeland Security during medical emergencies.

It was a level of efficiency very different from the norm at the rural 22-bed Florida emergency department where Dr. Ramirez regularly works. "My first night back, we barely squeaked through 85 patients," he said. "And everyone thought that was a good night."

The reason why there's such a difference? Medical care during disasters such as Katrina is immune from the pressure of treatment guidelines and prevention screenings that slow traffic through exam rooms around the nation. Whether a rural ED in Florida or a private practice in Ohio, this exploding cache of prevention strategies and lifestyle questions swells already packed schedules and demands on time -- even for physicians who firmly believe in the concept.

"There are so many preventive services possible that physicians often look to the task force recommendations to help prioritize and decide what's important for patients," says Ned Calonge, MD, MPH, chair of the U.S. Preventive Services Task Force and chief medical officer at the Colorado Dept. of Public Health and Environment in Denver.