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(Chest. 1999;115:909.)
© 1999 American College of Chest Physicians

A Dentist's Office Is the Template for Medicine

A. Jay Block, MD, FCCP*(Gainesville, FL ).

Emeritus Professor of Medicine, University of Florida College of Medicine, and Editor-in-Chief, CHEST.

I attended CHEST 1998 in Toronto, ON, Canada. Among the excellent lectures and discussions that I heard was the Presidential Address given by Robert McCaffree, MD, FCCP (see page 1155 in this issue of CHEST). While discussing the current state of medical practice, he mentioned that some managed care organizations have reduced actual patient contact time to 7 or 8 min. Presumably, this does not include the time it takes to write the detailed patient assessment required by the Health Care Financing Administration (HCFA)1 or to count the number of bullets that you have achieved and to calculate a bill.2

I don't know about the rest of you, but I had trouble getting a patient into an examining room and saying hello to them in 7 min. Presumably, if the patient was completely well, had no complaints, and just needed reassurance, this would be enough time.

The whole discussion reminded me of my visits to the dentist. One spends about one half hour with the dental technician getting plaque scraped, teeth cleaned, and radiographs taken. Then the dentist comes into the room and asks something like, "Are you taking good care of those pretty little teeth?"3 If you are lucky, the dentist may actually touch you by sticking a needle into very sensitive areas of your gums. All of this takes perhaps a minute.

Is this the future of medicine? Will you go to your doctor and spend one half hour with a nurse clinician or physician's assistant (PA)? Will they take the whole history and do a physical exam? Many rooms could be filled with patients undergoing this type of history and physical exam simultaneously. Then the doctor could enter each room for a minute or two and ask, "Are you taking good care of that pretty little body?" Perhaps the doctor would even touch your shoulder when asking this question.

The managed care companies would be ecstatic. This is the nirvana of profiteering medicine. We could speed up the system further by having preconstructed doctors' history and physical exam checklists so that HCFA would be satisfied. The physicians would only have to check off the answers that the nurse or PA had previously elicited. The great worry about this kind of system would be that the doctor might forget how to do a history and physical exam. Perhaps, if they are not necessary, medical schools would stop teaching students how to do them. Sir William Osler would turn over in his grave.

References

  1. Block, AJ (1997) The truth is the truth, and HCFA knows it [editorial]. Chest 111,531[Free Full Text]
  2. Hand, RW (1998) E & M guidelines: Is the medical record a database repository or a communication tool? [editorial] Chest 113,1432-1434
  3. Block LC. Very Personal Communication; November, 1998.




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