Should GPs work an extra six hours a day?

Evelyn Lewin

21/12/2018 12:11:46 PM

That is needed to ensure patients receive all necessary preventive care, according to a new – thankfully satirical – study.

Dr Morton Rawlin says general practice is a ‘changing environment’ in which preventive health features more than ever before.
Dr Morton Rawlin says general practice is a ‘changing environment’ in which preventive health features more than ever before.

In order to accommodate the additional hours for preventive care, primary care doctors’ sleep, personal hygiene and family time would need to take a back seat.
Thankfully, the study, ‘Much to do with nothing: microsimulation study on time management in primary care’, was written as a parody for the BMJ’s satirical Christmas edition.
While the suggestion that primary care doctors chain themselves to their desks until dusk was satirical, the findings were based on evidence-based national recommendations in the US from the Preventive Services Task Force – from colonoscopy and proactive lung cancer screening scans to immunisation and daily aspirin.
Researchers built and ran a computer simulation based on real-world data to reach their conclusions. They created a computer model of the way 1000 different doctors might spend their clinic time if they each had to take care of 2000 primary care patients and address recommendations about preventive care.
‘[One hundred per cent] of the study sample experienced a prevention-time-space deficit even given conservative (ie absurdly wishful) time estimates for shared decision making,’ the authors wrote.
The study found that, on average, GPs have 29 minutes each workday to discuss preventive care services – which translates to just over two minutes per consultation.
The researchers therefore concluded GPs would need an extra 6.1 hours per day to complete shared decision making for preventive care.
Dr Morton Rawlin laughed when he saw the results of this study, telling newsGP they ‘sound about right’.
While acknowledging the satirical nature of the study, Dr Rawlin said general practice is a ‘changing environment’ in which GPs focus on preventive health more than ever before.
‘That’s good for patients, but it’s also more difficult for us as GPs and primary care physicians to make sure that we give the best to our patients,’ he said.
Dr Rawlin was also quick to note that this satirical study looked at all the ways you can implement preventive and early-detection care strategies, which obviously isn’t how GPs approach such measures.
He said telling a patient everything they need to know, ‘would actually tend to dilute your message and it becomes too hard for the patient to actually understand’.
‘The good thing about being a GP is that you don’t have to do everything absolutely at the one time, so you can be a bit selective of what you actually do at a particular consultation. So you might focus on one particular area of prevention [at each visit],’ Dr Rawlin said.
Instead of applying such logic, the authors joked that doctors could ‘easily overcome’ the challenge of not having time in the day to address preventive health strategies in other ways.
‘For example, general practitioners could reduce the frequency of bathroom breaks to every other day and skip time with older children, who don’t like them much anyway,’ the authors joked.
‘This may be satire, but it actually allows us to make these points more strongly than we otherwise could,’ Tanner Caverly, the study’s lead author and a GP at University of Michigan’s academic medical centre, said.
Dr Caverly and his colleagues hope their paper also makes a point about physician wellbeing and burnout.
‘We did this as a serious paper written from a humorous standpoint that reinforces the serious issues more sharply,’ Dr Caverly said.
‘Now we need to analyse different ways of approaching these discussions with our patients.’
The authors say the subversive tone of the BMJ article is ‘meant to cast a bright light on the impossible set of demands doctors face and the absurdity of ignoring plain facts, such as that a doctor’s day cannot exceed 24 hours’.
While Dr Rawlin believes it is vital doctors ensure patients are exposed to the right information in order to allow them access to the best possible health outcomes, it should not come at a personal cost to the practitioner.
‘I think we as GPs have a huge amount of work that we can actually do, but you also need to look after yourself in this process,’ he said.

BMJ preventive care satire

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A Serious joke   8/01/2019 11:48:01 AM

How about door to door knocking, like missionaries do?
If Medicare pays.