Time and the patient-physician relationship

Being a physician always has been a busy job. This is especially true for primary care physicians who set as their goal the delivery and coordination of comprehensive care for patients. Achieving such a goal requires availability, a broad spectrum of medical knowledge, effective use of the local health care system, and attention to both the “big picture” and the details of a patient's life and health. The technical resources that go into the delivery of health care have been studied extensively. Major advances are frequent in the arenas of diagnostic testing, therapeutics, and pharmaceuticals. Modern information transfer technology has made physicians' ability to access information about these advances easier and contributed to patients being more aware of changes in many aspects of health care. At the same time, physicians may be called on to limit utilization of health care resources to services that are judged to be “medically necessary.” There has been relatively little study of physician time as a resource.1 Yet both as a contribution to health care costs and as a key element in patient-doctor relationships, there is reason to believe that it deserves more attention. Furthermore, with an increasing emphasis on value and efficiency in health care delivery, quality time between physician and patient is an increasingly valuable resource. Physicians spend time in face-to-face contact with patients gathering information, and developing a relationship, doing administrative work related to visits, and maintaining their knowledge base. Importantly, time is always finite: no matter what demands a physician faces, there are only 24 hours in a day. In the current practice environment, physicians face mounting demands on their time. Increasing administrative requirements for health care delivery (e.g., service and authorization requests, utilization review processes) encroach on time spent with patients. The 1995 Commonwealth Fund survey found that 41% of physicians noted a decline in the amount of time spent with patients and 43% noted a decline in the amount of time spent with colleagues between 1992 and 1995.2 Because of social and demographic changes in the physician workforce, many physicians have family responsibilities that reduce their time available for work. These factors have moved time management for physicians, in their practices and in their lives, to the forefront as a critical issue. In this article we examine the effects of limiting time on the patient-doctor relationship. We review the effects that are attributable to managed care. Finally, we offer recommendations for teaching medical students and residents skills that will help establish and maintain their patient-doctor relationships in the face of time pressure.