Health2.0 could crunch physicians

Well, I am a physician in general practice, and I saw 58 people today in seven hours in the clinic. Now I ask myself, with every one of these visits, whether it was a necessary visit, and from the patient's point of view, I would have to say yes. So I spent seven and a half minutes per patient, which includes listening and talking, examination, writing notes, writing prescriptions, writing lab and imaging orders, writing referrals, calling the emergency, calling the pharmacy. Not all these apply to each patient, but at least three or four of them do.

Some of the patients waited for an hour, some more....that's because it's a first come first serve no appointment clinic. We don't turn people away. So from the patient's point of view, there's a lot of wasted time sitting around. Even if one got into the queue, left and came back an hour or two later, there would still be a sense of makeshift time. And all this for an average of less than six minutes with the physician.

So if a patient could save two hours of travel and wait time, and instead spend fifteen minutes on an eHealth medium with the physician, and get all the things that you want, and HelloHealth promises, that would incur a demand of fifteen minutes of time from the physician. Where would this extra seven and a half minutes come from? Would I have to work fifteen hours a day to see the same 58 people each with fifteen minutes of electronic interaction? Or is there some sense that with eHealth tools, some of the 58 visits would not be needed? It's more likely that with increased communications capability and information, comes more questions and demand for answers. If no visits in a time-slice today are unnecessary, then all 58 visits will continue to be made, either face to face or electronically.

The problem here is that the total time spent waiting among the patient population could be considerably diminished, but if none of the visits were unnecessary, the physician still needs to interact with the same 58 people. While the benefits of eHealth could increase the time per interaction and decrease waiting times for the patient, where would it generate extra time for the physicians in a workday?

With HelloHealth, if each physician were paid for an hour of eVisit with one patient, would first of all this hour mean that six others would not be seen, and secondly, a small but not insignificant point, would the hour's visit cost seven times more than a visit with a physician in a clinic?

These are challenges that need to be faced squarely before we can implement on a population wide basis methods which are asymmetrical - reduce patient waiting time, increase patient interaction times, but without reducing demand on the same pool of physicians who are already struggling to meet the meeds of a population that feel underserviced with insufficient time and care.

Bottom line here - no matter how inefficient the office and wait times seem to be to the patient, the physician works very hard at producing a great clinical encounter in the seven minutes spent with a patient. Sometimes it doesn't work, usually it is satisfactory. It seems unlikely that eHealth, while making things quite a bit better for the patient, could improve the efficiency of the physician to permit more overall service time that would be incurred by the additional demands created by eHealth tools....huis clos