Nine Minutes

Like other docs, psychiatrists receive email surveys now and then asking about different aspects of life as a psychiatrist– about the medications favored for treating depression or anxiety, the fees charged for different types of patient visits, and the amount of time spent at work versus home.

I received such a survey last week, in multiple choice format.  Much of it was the same as usual, asking the things I described above and similar questions.  But one question made me pause for a moment, and to re-read the question and the choice of answers.

The question:  What is the average amount of time spent with each patient?

I looked for my answer among those listed:  a. 3 minutes; b. 6 minutes; c. 9 minutes; d. 13 minutes; or e.  20 minutes or longer.

That’s it?  No ’30 minute’ choice?  No 60 minutes?  I wondered if the survey was intended for a different specialty– perhaps for… for what, exactly?  I checked the survey email and sure enough, it was for psychiatrists.  And I wondered– how the heck can ANYONE take care of patients, based on appointments that last 9 minutes– let alone 3 minutes?!

I wondered if the answer template was chosen from a different survey; one that was used for a different medical specialty.  But when one thinks about it, is there ANY medical specialty, where the doctor can do a good job by seeing people for an average of 9 minutes?  I realize that the specialty of medicine has changed.  Doctors have ceased to be the friendly confidant, and are now ‘care gatekeepers.’  Somewhere, some doctor agreed to work for the insurer’s interest, accepting extra payment from the insurer in return for agreeing to keep the patient from seeing specialists– and now the role is taken for granted.  Isn’t that something?  Doctors being paid, by insurers, to prevent access to care.  The term for that, by the way, is ‘managed care.’  Funny how nice it sounds, “managed care.”  Almost sounds like a good thing!

I’m getting off track… if you wanted to see a neurologist for your migraines, but your family practice doctor wants to get his low-utilization bonus and DOESN’T want you to go to a neurologist, how long would you like to talk about it?  Four minutes?  OK, but you just wasted half your appointment!

Psychiatry visits, I would think, run a bit longer than some other areas of medicine. Patients sometimes speak more slowly;  they are sometimes less organized;  they might be confused.  As I think about the visits in my own practice, I recognize that I would have quite a challenge if I took the generous ’9 minute’ option…  we walk from waiting area to office.  Stop on the way to offer a soda from the fridge, or a cup of coffee.  Walk the rest of the way, and choose a place to sit.  Gosh– that’s three minutes right there, only six left.  The person then takes a moment to tell me that she lost her job;  I encourage her to tell me the story quick– in two minutes or less.  That leaves four minutes.  She wants to tell me about her impending divorce, or about the trouble her son is having in school–but I tell her to stick to the facts.  But still, just saying that took up another minute! Three left….

I tell her that we could try an SSRI.  Darn– she doesn’t know what THAT means– that’s going to be two more minutes, even if she doesn’t ask any questions.  I speak faster and faster, but watch as the second hand makes those final three full circles…  and I haven’t said anything about the risks, the other options, and of course the many non-medication things that she can do, to improve her mood.

You get the idea.

This situation, the gatekeeper issue, and many other issues– such as requirements to follow their treatment plans to THEIR liking– are a few of the reasons for me to opt out of health care networks and insurance panels.  As a physician and as a psychiatrist, I want to have ONE boss–and that is you, the patient.

I have a hard time understanding how anyone would want it any other way.

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