Many questions, little time: Physicians' tight schedules at odds with patient demands

Open-access scheduling and other approaches can free doctors to spend more time on patient concerns.

By Damon Adams, AMNews staff. March 12, 2007.

Jim Jirjis, MD, remembers a patient who came in with a long list of questions -- 17 to be exact.

He set aside 40 minutes for the physical exam, but the visit lasted 90 minutes, much to the disappointment of other patients in his waiting room.

Several years later, Dr. Jirjis is more savvy on how to cover a lot in a little time: He often asks patients to pick their top two or three concerns and deals with those during the encounter. The patient who had 17 questions now comes in with three or four.

"What happens is the important [issues] may be shortchanged if the doctor wants to get through 12 things," said Dr. Jirjis, director of general internal medicine and chief medical information officer at Vanderbilt University Medical Center in Tennessee. "Most patients understand you only have a certain amount of time."

A new national study of older patients found that physicians handle an average of six patient problems during a routine office visit, leaving precious few minutes to address them all adequately. About five minutes was devoted to the main topic, and the remaining concerns received about one minute each, according to the survey published online Jan. 24 in the journal Health Services Research.

Some of those remaining topics may have deserved more time, said lead study author Ming Tai-Seale, PhD, MPH, associate professor, School of Rural Public Health, Texas A&M Health Science Center.

Researchers reviewed videotapes of 392 visits to 35 primary care doctors by patients age 65 and older between 1998 and 2000. They examined the length and content of the encounters.