If you have a serious medical problem, the quality of the care you receive depends on whether three key objectives are met:
Studies of primary care office visits have found that physicians interrupt their patients an average of 18 to 23 seconds after they begin to speak and patients often fail to express all their true concerns after they are interrupted.
- Your physicians are fully informed about all important aspects of your condition;
- The care you receive from different physicians is carefully coordinated; and
- Your physicians fully inform you of the risks and benefits of your best alternatives and have the time to help you make an informed decision.
A medical advocate like Dr. Alan Laufman can help assure that those objectives are not jeopardized by time constraints, breakdowns in communication and other every day realities of the health care system, including:
• The prevailing fee-for-service system pays physicians based on the number of patients they treat. A growing proportion of physicians report having inadequate time to meet their patients’ needs. (1)
• Primary care physicians spend an average of 10.7 to 18.7 minutes face-to-face with each patient. (2) Studies of primary care office visits have found that physicians interrupt their patients an average of 18 to 23 seconds after they begin to speak and patients often fail to express all their true concerns after they are interrupted. (3)
• Communication between primary care physicians and specialists regarding referrals and consultations is often inadequate, with “negative consequences for patients.” A recent study found that only one-third of specialists said that all or most of the time they received notification of a patient’s history and reason for referral. Only about 60% of primary care physicians received consultation results all or most of the time. (4)
• Many health treatment and screening decisions have no single “best” choice. These types of decisions are considered “close calls” because there is scientific uncertainty about outcomes or there is a need to trade off known benefits and harms. (5) Standard physician counseling for “close call decisions” is inadequate. (6) There is considerable evidence that treatment decisions in many settings are characterized by “poor communication, significant knowledge gaps, and a lack of attention to patients' preferences for different health states.” (7)
The term “fragmented care” applies to patients receiving care from multiple clinicians who are not effectively communicating and sharing information.
• Medical care is error-prone even when care is delivered by a single provider. When multiple providers are involved, the opportunities for serious mishaps multiply. The term “fragmented care” applies to patients receiving care from multiple clinicians who are not effectively communicating and sharing information.
• Many features of the current health care system contribute to fragmentation of care: independent practices, limited use of electronic records and a payment system that fails to reward efforts to coordinate care and minimize the dangers of fragmentation. (8) An estimated 80% of serious errors involve miscommunication between caregivers when responsibilities for patients is transferred or handed off. (9)
1. Abbo ED et al. The Increasing Number of Clinical Items Addresses During the Time of Adult Primary Care Visits. J Gen Intern Med. 2008; 23:2058; Center for Studying Health System Change. So much to do, so little time: physician capacity constraints 1997-2001; 2003.
2. Krupa C. Referral silence irks specialists, primary care doctors alike. American Medical News. Jan. 31, 2011.
3. Marvel MK et al. Soliciting the Patient’s Agenda—Have We Improved? JAMA. 1999; 281:283; Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984; 101:692; Center for Studying Health System Change. So much to do, so little time: physician capacity constraints 1997-2001; 2003.
4. O’Malley AS, Reschovsky JD. Referral and Consultation Communication Between Primary Care and Specialist Physicians. Arch Intern Med. 2011: 171:56; Krupa C. Referral silence irks specialists, primary care doctors alike. American Medical News. Jan. 31, 2011.
5. O’Connor AM et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2009, Issue 3. Art. No.: CD001431.
6. O’Connor AM et al. Toward the “Tipping Point”: Decision Aids and Informed Patient Choice. Health Affairs. 2007; 26:716.
7. Sepucha K, Mulley AG. A perspective on the patient’s role in treatment decisions. Med Care Res Rev. 2009; 66:53S.
8. MacColl Institute for Healthcare Innovation. Reducing Healthcare Fragmentation: A Toolkit for Coordinating Care, 2011
9. Joint Commission Center for Transforming Healthcare. Joint Commission Center for Transforming Healthcare Tackles Miscommunication Among Caregivers. News Release, October 21, 2010.