M.D.s don’t have time to teach prevention

According to a Duke University study published in a recent issue of the American Journal of Public Health, medical doctors “don’t have time” to provide patients with information or recommendations on how to prevent health problems. Such service would, the researchers estimate, take an estimated 7.4 hours out of a primary care physician's day, leaving approximately 30 minutes for critical and chronic disease care.

“We know that prevention is very important for the health of our nation,” said Kimberly Yarnall, M.D., lead author of the study. “But what our study showed was that given the large number of recommendations -- everything from cancer screening to lifestyle counseling -- coupled with the large number of patients that most physicians are responsible for, it is simply not possible for physicians to deliver all those services to their patients. It's a big problem.”

Dr. Yarnall said that the average patient in a family practice waiting room needs 25 preventive services that have been recommended by the U.S. Preventive Services Task Force. Recommended services vary depending on age, sex, chronic disease status and gestation. Frequency of the services also varies from patient to patient.

Using these recommendations, the researchers assigned conservative time values to the tasks. They estimated the average number of patients a physician sees in a year to be 2,500 and used U.S. Census figures to model a patient panel with an age and sex distribution similar to that of the U.S. population, including children. Chronic disease statistics and pregnancy rates were also factored into the model. The calculations dramatically showed what Yarnall said doctors and patients have been reporting for years: that there is not enough time for all of the recommendations.

“Most would assume that the answer is to pare down the recommendations,” said Yarnall, “but even if we slashed the recommendations in half, it would still take half of every day, or half of every visit, to do half of what is now recommended. Prevention is critical, particularly since chronic disease rates in American adults and children are on the rise.”

Yarnall also said that the problem will become worse as baby boomers age and as new genetic tests become available.

Lloyd Michener, M.D., senior author on the study and chair of Duke University Medical Center’s department of community and family medicine, said that the solution to the problem of inadequate time for preventive care lies in creating a new health care model that uses a team of caregivers.

“By working together, we can offer the patient better care,” said Michener. “When we relieve physicians of the sole responsibility for prevention, we can free them up to handle more complicated disease management and acute care. Patients will have more time to discuss complex issues of care, while still receiving the quality preventive care that they need.”

SOURCE: American Journal of Public Health, April 2003.