The American health care system is all business. And unfortunately, the industry values treatment over prevention and drugs over lifestyle changes. The end result for patients isn’t ideal, as they end up taking more and more drugs to treat an illness, without addressing its root cause. For example, many of America’s most deadly diseases, like diabetes and cardiovascular disease, are largely caused by poor diet. Many of the nation’s major health insurance companies are stockholders in fast food companies, so obviously they aren’t looking out for patients. But why aren’t doctors spending more time talking with patients about lifestyle changes? In fact, they aren’t spending much time with patients at all.
Today’s primary doctor visits are commonly scheduled at 15-minute intervals, and some physicians who work at hospitals are asked to see a new patient every 11 minutes, according to a 2014 article from Kaiser Health News. Even in that short time frame, doctors probably aren’t listening attentively to their patients. A 1999 study of family doctor practices found doctors let patients speak for only 23 seconds before redirecting them, and only 25% of patients got to finish their statement. Another study, this one out of the University of South Carolina in 2001, found primary care patients were interrupted after just 12 seconds, either by the health provider or a knock at the door.
Some say the time crunch during doctor visits originated in part with Medicare’s 1992 adoption of a byzantine formula using “relative value units,” or RVUs, to calculate doctors’ fees. Not only that, the entire fee-for-service payment model dominating U.S. health care rewards physicians who see patients in bulk. The bottom line is, health providers aren’t financially incentivized to spend time talking to patients. In a 2015 Freakonomics interview, Jeffrey Brenner, a family doctor in New Jersey, says:
“In our system we have an asymmetry in price. So we pay a whole lot of money if you cut, scan, and hospitalize patients. If they have procedures, if they go through machines, we pay an enormous amount of money for those things. If you talk to a patient, you actually lose money in many instances. So when a cardiologist walks in the room and talks to your family member, that’s actually a loss leader. That doctor is losing money every moment they stay in a room with your family member. The way they make money is by getting you out of that room back into the scanner that they’re leasing in the back of the office. That’s not their fault. That’s the fault of how we’ve structured the incentives in the system.”
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