Past Featured Articles 

• As Good As It Could Get : Remaking the Medical Practice 
  Family Practice Management, May, 2000

• HMOs Best Stay Mum Regarding Hospice Care
  Managed Care, July, 2000

• Media violence is harmful to kids -- and to public health
  American Medical News, August 14, 2000

• Where were my dad's doctors?
  Medical Economics, May 22, 2000

• Same-Day Appointments: Exploding the Access Paradigm
  Family Practice Management, September, 2000

• Drs. Spend More Time With Patients
  The New England Journal of Medicine -- January 18, 2001 -- Vol. 344, No. 3

   

As Good As It Could Get : Remaking the Medical Practice 
Family Practice Management, May, 2000

"Our own experiences as users of offices and a growing body of literature suggest that clinical offices could be much better designed to meet patients' needs. A recent patient survey conducted by the Picker Institute revealed that large percentages of patients report problems in the following areas: access to care (23 percent), availability of reliable information and education (19 percent), respect for their preferences (13 percent), emotional support (19 percent), and coordination and continuity of care (19 percent).^"

The healthcare debate has been so dominated by economics for the past two decades that we have lost sight of what we really should be discussing - how we could better care for patients.  This is a wonderful article that finally addresses the issue.  See if you agree.... (full article)

HMOs Best Stay Mum Regarding Hospice Care 
Managed Care, July, 2000

By Michael S. Victoroff, M.D.

Why managed care can't do more to promote hospice care...(full article)

Media violence is harmful to kids -- and to public health
American Medical News, August 14, 2000

"Experts are expanding warnings about the dangers of exposing children to entertainment savagery -- including content from interactive computer and video games."

"At this time, well over 1,000 studies -- including reports from the surgeon general's office, the National Institute of Mental Health and numerous studies conducted by leading figures within our medical and public health organizations -- point overwhelmingly to a causal connection between media violence and aggressive behavior in some children," according to the statement, which was released at a July 26 congressional public health summit. (full article)

Where were my dad's doctors?
Medical Economics, May 22, 2000

For all who say, "See what managed care has wrought—there's no time for the human part of medicine," shame on you. No health plan administrator barred my dad's physicians from his room or prevented them from phoning the family. If his doctors were so busy or distracted by the demands of managed care that they couldn't do their jobs in a humane way, then they've ceased to be the healers they trained to be.

My dad deserved better. (full article)

Same-Day Appointments: Exploding the Access Paradigm
Family Practice Management, September, 2000

The access model we created is often called "open access," "advanced access" or "same-day scheduling." It has one very simple yet challenging rule: Do today's work today. Doing so enables patients to see their own personal physician on the day they call for any problem, whether urgent, routine or preventive. In less than one year, it reduced our 55-day wait to just one day, it increased dramatically the odds of patients seeing their own personal physician, and it improved physician, patient and staff satisfaction. We are even gathering evidence that it improves clinical outcomes as well.

This is the successor to a previously featured article, "As Good As It Could Get : Remaking the Medical Practice".  It focuses on the importance and means of creating better access to office care...(full article)

Drs. Spend More Time With Patients

The New England Journal of Medicine -- January 18, 2001 -- Vol. 344, No. 3

By JEFF DONN, Associated Press Writer

A new study disputes the widely held notion that managed care has put a heavy squeeze on the amount of time doctors are spending with their patients. If anything, office visits may be getting longer.

The study, based on surveys of doctors and their staffs, looked at more than 200,000 office visits over 10 years.

The average length of an office visit climbed two minutes between 1989 and 1998 to 18 minutes, based on surveys done by National Center for Health Statistics. It rose by one minute, to about 21 minutes, based on surveys done by the American Medical Association.

``Doctors have always complained about not having enough time for patients,'' said David Mechanic, a Rutgers University sociologist who led the study. With the rise of managed care, ``now they have somebody to blame for something that always existed.''

The study was published in Thursday's New England Journal of Medicine (full article).

Managed care patients accounted for a growing share of office visits during the period, climbing from 15 percent to 33 percent. Yet the average time spent by doctors during office visits was roughly the same whether patients were covered by managed care or traditional insurance.

Though doctors widely complain that patients are getting shortchanged, some studies suggest that patients themselves are generally satisfied with the care they get. Many patients say they would like more time with their doctors, though. And politicians have joined in the complaints.

``The rhetoric in the political arena is really too simple. It describes the situation in the health care system on anecdotes, not on reality,'' said Karen Ignagni, president of the American Association of Health Plans, which represents the managed care industry.

The Rutgers study was funded by the Robert Wood Johnson philanthropic foundation. Mechanic, who directs Rutgers' Institute of Health Care Policy, said he is not on the payroll of any managed care group.

The researchers did suggest some changes in recent years that may have placed more demands on doctors' time. Doctors are also treating more complex cases during office visits instead of in the hospital. They must evaluate an ever-broader range of treatments and do more preventive care, advising patients on smoking, obesity and other dangers.

With the expansion of the Internet and drug advertising, many patients are also asking more questions, doctors said. With the rise of managed care, many doctors also complain of too much paperwork.

``Office visits seem short because there is more to do, more to think about, and more that is expected,'' said Dr. Edward Campion, a deputy editor at the journal.

Dr. Jerome Kassirer, a Tufts University professor and former journal editor who has written about doctor morale, said the study carries a few potential sources of error. For example, the length of office visits was not objectively measured but was instead reported by doctors or their staff.

However, he said, ``I have a perception that doctors feel rushed not only with respect to seeing patients, but also with lots of administrative and bureaucratic activities.''