Brief is Good

How long does it take to diagnose guttate psoriasis versus pityriasis rosea? Swimmers ear versus a ruptured eardrum? A kidney stone? A urinary tract infection? An ankle sprain?

So why is the typical “cycle time”, the time it takes for a patient to get through a clinic such as mine for these kinds of problems, close to an hour?

Answer: Mandated screening activities that could actually be done in different ways and not even necessarily in person or in real time!

Guess how many emergency room or urgent care center visits could be avoided and handled in the primary care office if we were able to provide only the services patients thought they needed? Well over 50% and probably more like 75%.

Primary Care clinics like mine are penalized if a patient with an ankle sprain comes in late in the year and has a high blood pressure because they are in pain and that becomes the final blood pressure recording for the year. (One more uncontrolled hypertensive patient.)

We also get penalized if we see an infrequent visitor only once in a given year and don’t screen and provide interventions for depression, alcohol use, smoking and a host of other conditions unrelated to what the patient came to us for.

So we can’t afford to have quick visits since anything less than comprehensive makes us look bad.

Imagine if you pull up to an ATM for $40 in cash and the machine insists on going over your annual budget with you. That’s what primary care feels like sometimes.

Of course I will look one or two steps beyond the chief complaint. If a smoker has bronchitis, I’ll talk about smoking. And if an alcoholic falls down his front steps, I will take the opportunity…

But I can’t do everything for everybody in every visit. I can be comprehensive, over time, if I am not penalized for squeezing In patients with simple problems for quick visits. I think that is more comprehensive than declining to provide rapid access and thereby forcing patients to fragment their care between multiple unrelated providers.

Here is my simple prayer:

Dear Overlords of CMS and all you other Healthcare Policymakers and Deities,

Let us judge how to best meet our patients’ needs when they come to our clinics. Admit that sometimes a sore throat is just a sore throat.

11 Responses to “Brief is Good”


  1. 1 Ralph K Allen May 7, 2019 at 2:25 pm

    we have stayed with our primary care physician for almost 25 years. Our visits are valuable and he is consistently the best primary care person ever.
    Hopefully he will remain in practice beyond our life-on-earth experience. If one’s doctor is consistent and one is patient and learns, one is in good hands forever.


  1. 1 Brief is Good – Health Econ Bot Trackback on May 28, 2019 at 10:43 am
  2. 2 Brief is Good | Health Advice and more Trackback on May 28, 2019 at 10:47 am
  3. 3 Brief is Good Trackback on May 28, 2019 at 10:53 am
  4. 4 Brief is Good – BrighterLife Trackback on May 28, 2019 at 11:07 am
  5. 5 Brief is Good – Site Title Trackback on May 28, 2019 at 11:07 am
  6. 6 Brief is Good – Health News Trackback on May 28, 2019 at 1:06 pm
  7. 7 Brief is Good – Health Benefits Trackback on May 28, 2019 at 1:07 pm
  8. 8 Brief is Good – Techno Hub Trackback on May 28, 2019 at 1:09 pm
  9. 9 Brief is Good – The Health Care Blog - Trackback on May 28, 2019 at 9:25 pm
  10. 10 Brief is Good – Ultimate Self Hack Trackback on May 28, 2019 at 10:12 pm

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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