Thursday, August 5, 2010

Doctors Don’t Have Time To Explore Social Factors When Making A Patient Diagnosis

Preface: Kevin Pho, MD, America’s best known medical blogger, wrote the following blog. He is quite right. Under the current reimbursement system, primary care doctors don’t have the time or incentives to explore or to meet the social needs of patients. Rebecca Ione, CEO of Project Health, which now operates in six major cities, has come up with a partial solution. Her organization trains college volunteers, many of them premedical students, to set up “Help Desks” in clinics and hospital ERs, to help families find social services – housing, food stamps, job placement, other social services, and transportation. Doctors in clinic, hospital, and pediatric settings can now write “prescriptions” to the help desks so volunteers can assist patients and their families in getting social help. You may link to his blog at

"A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis.

Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.”

Evan Falchuk, commenting on the results, provides some context:

It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doctors, although it’s worse for patients. What the researchers call a failure to “individualize care,” a patient might call “not being paid attention to.” It’s a dynamic that anyone who’s been ill has probably seen first-hand.

These findings are entirely unsurprising. Uncovering social factors that potentially underlie a patient’s symptoms takes time to find out. And sometimes, patients are reluctant to disclose their social situation to doctors until a relationship is made — an acknowledged limitation of the study, which only observed first-time encounters.

Primary care doctors are restricted by a payment system that doesn’t value time, and subsequently, 'most physicians are under incredible time pressure and don’t want to go there because it could open up a whole can of worms.'

The best way to value time is to pay primary care doctors by the hour. Reduce the pressure to see a huge number of patients. And you’ll miraculously see the problems brought forth by this study markedly improve."

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