The doctor will see you shortly
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Many physicians and health care leaders express concern about the amount of time available for clinical practice. While debates rage on about how much time is truly available, the perception that time is inadequate is now pervasive. This perception has ethical significance, because it may cause clinicians to forego activities and behaviors that promote important aspects of the patient-physician relationship, to shortcut shared decision making, and to fall short of obligations to act as patient advocates. Furthermore, perceived time constraints can hinder the just distribution of physician time. Although creating more time in the clinical encounter would certainly address these ethical concerns, specific strategies—many of which do not take significantly more time—can effectively change the perception that time is inadequate. These approaches are critical for clinicians and health systems to maintain their ethical commitments and simultaneously deal with the realities of time.
- Arnold E, Pulich M. Improving productivity through more effective time management. Health Care Manag (Frederick). 2004;23:65–70.
- Crosby JW. Ten time-management tips for family physicians. CMAJ. 2004;170:949–50.
- Lussier MT, Richard C. Doctor-patient communication: taking time to save time. Can Fam Physician. 2004;50:1087–9.
- McClennan B. Achieving greater patient throughput. Am J Roentgenol. 2004;183(3 suppl):9.
- Phipps GS. Seven keys to on-time finishing. J Clin Orthod. 2004;38:155–8.
- Waters DA. The 15-minute appointment: sacred cow? Arch Pediatr Adolesc Med. 2004;158:603. CrossRef
- Guglielmo WJ. How to set up a concierge practice. Med Econ. 2003;80:64–8.
- Stafford RS, Saglam D, Causino N, et al. Trends in adult visits to primary care physicians in the United States. Arch Fam Med. 1999;8:26–32. CrossRef
- Mechanic D, McAlpine DD, Rosenthal M. Are patients’ office visits with physicians getting shorter? N Engl J Med. 2001;344:198–204. CrossRef
- Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the physician worklife study [see comments]. J Gen Intern Med. 2000;15:441–50. CrossRef
- Tocher TM, Larson EB. Do physicians spend more time with non-English-speaking patients? [see comments]. J Gen Intern Med. 1999;14:303–9. CrossRef
- Burdi MD, Baker LC. Physicians’ perceptions of autonomy and satisfaction in California. Health Aff (Millwood). 1999;18:134–45. CrossRef
- Groenewegen PP, Hutten JB. Workload and job satisfaction among general practitioners: a review of the literature. Soc Sci Med. 1991;32:1111–9. CrossRef
- Grol R, Mokkink H, Smits A, et al. Work satisfaction of general practitioners and the quality of patient care. Fam Pract. 1985;2:128–35. CrossRef
- Mawardi BH. Satisfactions, dissatisfactions, and causes of stress in medical practice. JAMA. 1979;241:1483–6. CrossRef
- Pollock K, Grime J. Patients’ perceptions of entitlement to time in general practice consultations for depression: qualitative study. BMJ. 2002;325:687. CrossRef
- Cape J. Consultation length, patient-estimated consultation length, and satisfaction with the consultation. Br J Gen Pract. 2002;52:1004–6.
- Lang F, Floyd MR, Beine KL, Buck P. Sequenced questioning to elicit the patient’s perspective on illness: effects on information disclosure, patient satisfaction, and time expenditure. Fam Med. 2002;34:325–30.
- Kurtz SM, Silverman J, Draper J, Silverman J. Teaching and Learning Communication Skills in Medicine. 2nd ed., Oxford: Radcliffe Pub.; 2005.
- Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database Syst Rev. 2001;CD003267.
- Silverman J, Kurtz SM, Draper J, Kurtz SM. Skills for Communicating with Patients. 2nd ed. Oxford, UK: Radcliffe Pub.; 2005.
- Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267:2221–6. CrossRef
- Ramsey P. The Patient as Person: Explorations in Medical Ethics. New Haven: Yale University Press; 1975.
- Veatch RM. Modern vs. contemporary medicine: the patient-provider relation in the twenty-first century. Kennedy Inst Ethics J. 1996;6:366–70. CrossRef
- Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad Med. 2003;78:802–9. CrossRef
- Kurtz SM, Silverman JD. The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ. 1996;30:83–9. CrossRef
- Cote L, Belanger N, Blais J. The patient-centered interview and the way it is taught. What do family physicians who have recently received their degree think? Can Fam Physician. 2002;48:1800–5.
- Lipkin M Jr., Quill TE, Napodano RJ. The medical interview: a core curriculum for residencies in internal medicine. Ann Intern Med. 1984;100:277–84.
- Platt FW, Gaspar DL, Coulehan JL, et al. “Tell me about yourself”: The patient-centered interview. Ann Intern Med. 2001;134:1079–85.
- Fiscella K, Meldrum S, Franks P, et al. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care. 2004;42:1049–55. CrossRef
- Teutsch C. Patient-doctor communication. Med Clin North Am. 2003;87:1115–45. CrossRef
- Deckard G, Meterko M, Field D. Physician burnout: an examination of personal, professional, and organizational relationships. Med Care. 1994;32:745–54. CrossRef
- Kao A, Green D, Davis N, Koplan J, Cleary P. Patients’ trust in their physicians: effects of choice, continuity, and payment method. J Gen Intern Med. 1998;13:681–6. CrossRef
- Kao A, Green D, Zaslavsky A, Koplan J, Cleary P. The relationship between method ofphysician payment and patient trust. JAMA. 1998;280:323–9. CrossRef
- Safran D, Kosinski M, Tarlov A. The Primary Care Assessment Survey: test of data quality and measurement performance. Med Care. 1998;36:728–39. CrossRef
- Braddock CH III, Micek MA, Fryer-Edwards K, Levinson W. Factors that predict better informed consent. J Clin Ethics. 2002;13:344–52.
- Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.
- Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th ed. New York, NY: Oxford University Press; 2001.
- Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7. CrossRef
- American College of Physicians Ethics manual. Fourth edition. Ann Intern Med. 1998;128:576–94.
- Morreim EH. From advocacy to tenacity: finding the limits. J Am Geriatr Soc. 1995;43:1170–2.
- Daniels N. Just Health Care. Cambridge: Cambridge University Press; 1985.
- Buller MK, Buller DB. Physicians’ communication style and patient satisfaction. J Health Soc Behav. 1987;28:375–88. CrossRef
- Like R, Zyzanski SJ. Patient satisfaction with the clinical encounter: social psychological determinants. Soc Sci Med. 1987;24:351–7. CrossRef
- Robbins JA, Bertakis KD, Helms LJ, Azari R, Callahan EJ, Creten DA. The influence of physician practice behaviors on patient satisfaction. Fam Med. 1993;25:17–20.
- Giron M, Manjon-Arce P, Puerto-Barber J. Clinical interview skills and identification of emotional disorders in primary care. Am J Psychol. 1998;155:530–5.
- Hemenway D, Killen A, Cashman S, Parks C, Bicknell W. Physicians’ responses to financial incentives: evidence from a for-profit ambulatory care center. N Engl J Med. 1990;322:1059–63. CrossRef
- Radecki S, Kane R, Solomon D, Mendenhall R, Beck J. Do physicians spend less time with older patients? J Am Geriatr Soc. 1988;36:713–8.
- Stiles W, Putnam S, Wolf M, James S. Interaction exchange structure and patient satisfaction with medical interviews. Med Care. 1979;17:667–81. CrossRef
- Kass-Bartelmes BL, Hughes R. Advance care planning: preferences for care at the end of life. J Pain Palliat Care Pharmacother. 2004;18:87–109.
- Lang F, Quill T. Making decisions with families at the end of life. Am Fam Physician. 2004;70:719–23.
- Forjuoh SN, Averitt WM, Cauthen DB, Couchman GR, Symm B, Mitchell M. Open-access appointment scheduling in family practice: comparison of a demand prediction grid with actual appointments. J Am Board Fam Pract. 2001;14:259–65.
- Institute for Healthcare Improvement. Idealized Design of Clinical Office Practices. Boston, MA: Institute for Healthcare Improvement; 2000.
- O’Hare CD, Corlett J. The outcomes of open-access scheduling. Fam Pract Manage. 2004;11:35–8.
- Scott JC, Conner DA, Venohr I, et al. Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004;2:1463–70. CrossRef
- The doctor will see you shortly
Journal of General Internal Medicine
Volume 20, Issue 11 , pp 1057-1062
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- medical ethics
- time management
- patient-physician relations
- Industry Sectors