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Join Us! 3rd Annual Family Day & Health Fair!!

Sunday, 19 November, 2017
Generations Health Fair

Please join Generations Family Practice and SpineCare Chiropractic Center at our 3rd ANNUAL PAR-TEE ~ SATURDAY, OCTOBER 11, 2014 from 11:30am-2pm.

This fun family event celebrates our patients and community with an afternoon of health-related activities and education, championship golf watching, yummy food and activities for the kids.

Come out and enjoy:

  • Free Health Screenings & Demonstrations
  • Learn about Rejuvapen & other Cosmetic Service Offerings! (Attendees will receive discounts on certain products and procedures)
  • SAS Golf Championship viewing from our yard!
  • Food Trucks! Philly’s Cheesesteaks & Lil Dippers Italian Ice
  • Face Painting by Paint Savvy
  • Family Games
  • Flu & Pneumonia Vaccine Clinic*
  • Expired drug drop-off
  • Prize drawings

All activities will take place at our Cary office located at 110 Preston Executive Drive, Cary, NC 27513. No reservations are required! For more information, please call us at (919)852-3999.

We look forward to seeing you there!

[*Fee may apply for flu and pneumonia vaccines. We can file insurance for all current patients.]

What you need to know about Enterovirus D-68

Sunday, 19 November, 2017
Enterovirus D-68

As of two days ago, the respiratory virus, Enterovirus D- 68, which has been sending hundreds of kids to emergency rooms in the Midwest, has not been reported in North Carolina, despite previous reports, according to the North Carolina Department of Health and Human Services, Division of Public Health. However, we at Generations Family Practice, remain vigilant.

Enteroviruses are very common viruses, however the EV-D68 strain is not one of the more common strains. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious.  EV-D68 which has been seen in infants, children, and teenagers has been associated almost exclusively with respiratory disease, which can range from mild to severe. Those are increased risk for more serious infections include those with respiratory conditions and heart conditions.

There is no specific treatment for EV-D68 infections. Many infections will be mild and self-limited, requiring only symptomatic treatment. Patients with asthma exacerbations or other more severe manifestations may require hospitalization for supportive therapy. Vaccines for preventing EV-D68 infections are not currently available.

 What can we do to help reduce the risk of infection with EV-D68 and other respiratory viruses?

  1. Wash hands often with soap and water for 20 seconds;
  2. Avoid touching eyes, nose, and mouth with unwashed hands;
  3. Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick;
  4. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick; and
  5. Stay home when feeling sick, and obtain consultation from your health care provider.
  6. Get the flu vaccine

What should we be watching for in our children?

  1. Most children most likely will have only mild illness, like a common cold. However signs that your child needs more attention include:
  2. Signs of difficulty breathing such as increased rate of breathing, increased work to breath (as indicated by flaring of the nostrils, use of belly/rib muscles to help breath,) wheezing or grunting;
  3. Bluish color around the lips;
  4. Changes in alterness;
  5. Poor feeding or drinking

If you have any questions about your child’s condition or if you notice any signs that your child might be having trouble with his/her breathing, call our office at (919) 852-3999.

Health Insurance and Substance Abuse Treatment in the United States

Sunday, 19 November, 2017
substance abuse treatment and insurance

Health Insurance and Substance Abuse Treatment in the United States

by Richard Glaser

From one side of the United States to the next, substance abuse remains a problem. There are millions of people with an addiction to drugs and/or alcohol, however, some are unsure of what type of treatment is best for them and how they will pay for it.

For those with health insurance, there is a lot to know about the type of treatment that is covered as well as the facilities at which you can receive assistance.

More than 15,000 Drug Rehab Facilities

According to DrugAbuse.gov, there are more than 15,000 drug rehab facilities in the United States. Each and every one provides one or more of the following:

  • Counseling
  • Therapy
  • Case management
  • Detoxification

While many are happy to find that there is a facility that is willing to help, this leads to one very important question: how are they going to pay for treatment?

Since substance abuse has become such a large problem in the United States, a portion of treatment is funded by governments, including federal, state, and local. If treatment is paid for in full through this type of funding, the patient does not have much to worry about from a financial perspective. Unfortunately, this is not typically the case. You will likely find yourself on the hook for some portion of the treatment.

Many employer sponsored and private health insurance plans are now providing coverage for substance abuse treatment, as well as any health issues that may arise as a direct result.

Contact your Insurance Company

With so many insurance policies available in today’s day and age, the only way to know if yours covers substance abuse treatment is to reach out to your provider. By doing so, you can learn more about your particular policy, including what it has to offer if you need addiction treatment.

The following major health insurance carriers provide substance abuse treatment under most of their policies:

  • Blue Cross Blue Shield
  • Aetna
  • Cigna
  • United Healthcare

How much will my Insurance Cover?

In the event that you require professional substance abuse treatment, you should contact your health insurance provider to discuss your plan. During this time, ask the following questions:

  • Does my policy cover substance abuse treatment?
  • How much will my policy cover?
  • Are there any limitations that I need to be aware of?

Some policies will cover your entire bill, after your deductible has been met, but others only pay for a portion of your overall cost.

Consider your Options

A recent report by HBO.com noted that there are many people who do not have an insurance plan that covers addiction treatment. Here are some of the primary details to be aware of:

  • Don’t shy away from fighting your health insurance company if they are obligated to pay for all or some of your substance abuse treatment
  • Most states have a law that requires your health insurance provider to cover addiction treatment
  • If you receive coverage through your employer, ask your HR professional for more information on the policy
  • If you purchase your own coverage, contact the insurance company for policy related information

Did you know that the economic impact of untreated addiction among Americans has reached roughly $325 billion per year? This is why states and the federal government are making major changes, many which require health care plans to cover substance abuse treatment. Cost savings, when the appropriate treatment schedule is in place, can equal $7 to $12 for every $1 spent.

Marketplace Insurance Plans

With millions purchasing coverage through the new marketplace, many are wondering if these plans cover substance abuse services. In short, all marketplace insurance plans cover substance abuse services as well as mental health treatment.

In an effort for the government to help treat those with mental health or substance abuse issues, all plans available through the marketplace must cover the following 10 categories of essential health benefits:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventative and wellness services and chronic disease management
  • Pediatric services

Pre-existing Conditions

Adding to the above, marketplace plans cannot deny you coverage or charge you additional money if you have a pre-existing condition. This includes substance use disorders. As soon as your marketplace plan goes into effect, coverage for treatment of pre-existing conditions will begin.

No Dollar Limits

There are no lifetime or yearly dollar limits for marketplace plans, including benefits for substance use disorders. For those who have a continuing problem or require long term treatment, this is a financial savior.

Parity Protections

All marketplace plans must provide “parity” protections between substance abuse benefits and medical benefits. This means that limits applied to substance abuse services cannot be more restrictive than those applied for medical services. The types of limits covered include:

  • Financial: such as copayments, deductibles, coinsurance, and out of pocket limits
  • Care management: such as being required to receive authorization for treatment before moving forward
  • Treatment: such as the number of visits or days covered by the policy

Every year, drug abuse and addiction costs the United States hundreds of billions of dollars. For example, employers lose $122 billion dollars in lost productivity and another $15 billion in health insurance costs on an annual basis.

By making changes to the health insurance system, such as the coverage provided by plans through the marketplace, the government is making it easier and more affordable for those with a substance abuse problem to receive the proper treatment.

[Shared with permission from Rehabilitation Center Cost]

Evolution of the Flu Vaccine

Sunday, 19 November, 2017

The flu has had quite an impact on society over time. Take a look at a brief history of the flu vaccine's history and how we've battled it medically. All the more reason to get your flu shot scheduled! Call us today!!

What every man should know!

Sunday, 19 November, 2017

Prostate cancer is the second most common cancer among American men. Every year, 1 in 6 men will be diagnosed with the disease. But prostate cancer is one of the most treatable malignancies, if caught early.

To view the full graphic, click here.

Fun and Healthy Fourth of July Recipes!

Sunday, 19 November, 2017

Fourth of July is just around the corner. Finding delicious, yet healthy recipes that everyone will enjoy can be challenging. We thought we'd take some of the guess work out for you this year. Searching through piles of recipe cards, we came up with the following menu to make your backyard BBQ a success. Have a happy Fourth of July!!

BBQ Chicken Sandwiches

Enjoy barbeque flavor without the added fat and calories. Using low-fat sour cream keeps this feeling meal light!

Ingredients

  • 1 3/4 pounds sliced onion (about 3)
  • 6 garlic cloves, halved
  • 2 teaspoons olive oil
  • 1 pound skinless, boneless chicken thighs (about 4 thighs)
  • 1/2 cup jarred barbecue sauce
  • 2 tablespoons light sour cream
  • 1 1/2 tablespoons cider vinegar
  • 1 teaspoon agave syrup or honey
  • 6 ounces cabbage-and-carrot coleslaw mix
  • 1/4 teaspoon pepper
  • 4 ciabatta rolls, toasted

Instructions

  1. Preheat broiler. Place onion and garlic on a foil-lined baking sheet; toss with oil. Broil 5 minutes, 6 inches from heat, until onion is golden, stirring often.
  2. Preheat oven to 425°. Transfer onion mixture to a square glass baking dish; top with chicken. Pour barbecue sauce over chicken; cover tightly with foil. Bake, in middle of oven, until chicken is cooked through (about 20 minutes).
  3. Combine sour cream, vinegar, and honey; whisk well. Toss with coleslaw mix and pepper.
  4. Shred chicken with a fork; top bottoms of rolls with chicken, onion, sauce mixture, and coleslaw. Place roll tops on sandwiches.

Potato Salad

Purple potatoes are good for your heart and red potatoes are packed with fiber and vitamin C. This salad is a very low-calorie – just 145 calories – side dish for your summer barbecue.

Ingredients

  • 1/4 cup cider vinegar
  • 2 teaspoons sugar
  • 1/4 teaspoon pepper
  • Salt
  • 2 teaspoons yellow mustard seeds
  • 2 cups diced red cabbage
  • 1 bag (about 24 oz.) tricolor baby potatoes, scrubbed and sliced
  • 2 tablespoons safflower or canola oil
  • 1/4 cup minced chives

Instructions

  1. In a bowl, stir vinegar, sugar, pepper and 1/2 tsp. salt until sugar dissolves. Stir in mustard seeds and cabbage.
  2. Bring a pot of salted water to a boil. Add potatoes, return to a boil and cook until just tender, about 10 minutes.
  3. Drain potatoes; let cool slightly. Fold into cabbage mixture with oil and chives. Serve warm or at room temperature.

Grilled Watermelon, Mint, and Feta Salad

This fresh, mouth-watering summer salad takes seconds to prepare, and has only 122 calories per serving.

Ingredients

  • 1 small watermelon (about 6 pounds), cut into 1-inch-thick rounds (lay melon on its side, and cut through rind and flesh with a sharp knife)
  • 1/2 cup small mint leaves, torn
  • 2 ounces feta cheese, crumbled into large chunks
  • 1 tablespoon olive oil
  • 1 tablespoon balsamic vinegar
  • 1/4 teaspoon sea salt
  • 1/4 teaspoon black pepper

Preparation

  1. Heat a grill or grill pan over high heat until very hot. Two at a time, grill watermelon rounds, turning once, until charred (about 2-3 minutes per side). Transfer watermelon to a cutting board and remove rind; cut rounds into wedges.
  2. Arrange watermelon on a serving platter; sprinkle with mint and feta. Drizzle with olive oil and vinegar, then sprinkle with salt and pepper.

Blueberry-Lemon Sorbet

It's hard to believe that this sorbet helps prevent age-related memory loss and cell damage. That's thanks to the antioxidant-rich blueberries. Don't miss out on summery treats because of calories. This sorbet is just 77 calories a serving with no fat.

Ingredients

  • 3 cups fresh or frozen blueberries, thawed
  • 1/2 cup water
  • 2 tablespoons honey
  • 1 teaspoon lemon zest
  • 2 tablespoons fresh lemon juice
  • 1/8 teaspoon salt

Preparation

  1. Place all ingredients in a blender or food processor; process until smooth. Place berry mixture in a freezer-safe container and freeze until hard, about 1 hour. Let stand about 10 minutes before serving.

Look younger - have healthier looking skin! Without having to go under the knife.

Sunday, 19 November, 2017
Before and After photos Rejuvapen

Wouldn't it be nice to look younger? To have healthier looking skin? Now you can without having to go under the knife or spend days or weeks recovering while missing personal, work, and family obligations!

Generations Family Practice is pleased to offer Rejuvapen™, our newest skin care treatment. This advanced technology stimulates the skin's natural healing process to increase elasticity, reduce the appearance of scars and wrinkles, minimize pores, and more. A versatile treatment that corrects a variety of skin concerns, Rejuvapen is an attractive option for men and women seeking comprehensive skin rejuvenation without invasive surgery. And at a much lower cost than you would expect!

Why Rejuvapen over another procedure or facelift? Here are some top reasons:

1. No surgery

Rejuvapen is non-surgical, which means that it comes with less risk and no scarring, unlike procedures that require an incision. Rejuvapen treatments are non-invasive and treatments are performed at our Cary office under the supervision of one of our physicians.

2. No anesthesia

Because no anesthesia is necessary, the chance of complications is minimized, and surgical risks, such as infection, are also greatly reduced. You can be fully awake when receiving treatment for Rejuvapen.

3. No lost time

When you receive a facelift at a medical facility, patients are typically kept overnight for recovery and supervision. Since Rejuvapen is non-invasive, you may continue with your day within an hour. And unlike a face lift, Rejuvapen does not require an at-home recovery period. A facelift can derail your personal, work and family obligations by keeping you at home and out of sight while you recover and heal from surgery. A treatment with Rejuvapen will not keep you from your day-to-day responsibilities and activities.

4. No embarrassing bruising or scarring

While a facelift will have moderate to severe bruising for days and sometimes, weeks, you will not experience either with a treatment from Rejuvapen. Those receiving treatment from Rejuvapen recover in 24 hours or less and only experience the feeling of a 'mild sunburn.'

5. Little to no pain

When you user Rejuvapen, a topical numbing cream is applied prior to treatment so there is little to no pain involved during and after treatment.

6. Reduced risk of infection

Because Rejuvapen is non-surgical, you dramatically reduce the risk of infection.

7. Get results quicker

It can take up to 6-9 months to see the full benefits of a facelift. The results of Rejuvapen typically take between 6 and 8 weeks to become visible.

Call Generations today to learn more about this exciting procedure! (919) 852-3999.

BENEFITS OF GENERATIONS PREMIUM #3 - MORE TIME WITH YOUR DOCTOR = BETTER PREVENTATIVE HEALTH CARE!

Sunday, 19 November, 2017

BENEFITS OF GENERATIONS PREMIUM #3 - MORE TIME WITH YOUR DOCTOR = BETTER PREVENTATIVE HEALTH CARE!

"An ounce of prevention is worth a pound of cure." Benjamin Franklin was one smart guy! Healthcare that emphasizes preventative medicine saves time, money and most importantly lives!

View the full infographic

[Shared from www.saintpetersuniversityonline.com]

5 Things Your Mother's Health Says About Yours

Sunday, 19 November, 2017

Here's what you can learn from your mother's health, and how to apply these insights to age more healthfully. You've watched your mother as she weathers the passing years, wondering if you'll be lucky enough to stay as fit and lively as she is, or unlucky enough to share her memory issues or health concerns. Here's what you can learn from your mother's health, and how to apply these insights to age more healthfully.

1. When you'll go into menopause

Genetics, it turns out, are a fairly reliable gauge for the onset of menopause; in fact, one study found that the age of menopause is 85 percent determined by genes. Most women enter perimenopause somewhere between 39 and 51; from there it takes approximately five years before your periods stop altogether (marking the official start of menopause). As a general rule, your periods will stop at around the same age as your mother's did. However, certain lifestyle factors, like smoking and living at a high altitude, can bring menopause on ahead of schedule.

What your mother's menopausal age won't tell you: Whether your menopausal symptoms will be mild or extreme. Many factors, like weight, diet, how much you exercise, and your stress level, play into whether you'll be plagued by hot flashes, mood swings, and other symptoms -- or sail through menopause with minimal misery.

2. Whether you're at increased risk of breast cancer

There's a reason doctors always ask you whether you have a first-degree relative with breast cancer. Between 5 and 10 percent of breast cancer cases are inherited, and having a mother with breast cancer is even more significant, doubling your breast cancer risk. Then there are the genes BRCA1 or BRCA2, which can raise your breast cancer risk as high as 60 percent. But these statistics only carry you so far; 70 percent of all women with breast cancer have no close relatives with the disease. And keep in mind that there are many environmental and lifestyle influences on cancer risk, from chemical exposure to whether and when you had children to smoking and alcohol consumption.

What your mother's breast cancer history won't tell you: Whether or not you'll get breast cancer, and how serious it will be if you do. Fewer than one in ten cases of breast cancer has a hereditary component. And it's the stage at which cancer is detected that plays the biggest role in whether it's curable.

3. How likely you are to get osteoporosis

If your mother has been diagnosed with osteoporosis, is fracture-prone, or even is simply thin and small-boned, you need to pay attention to your bone health. Bone structure is greatly influenced by heredity; in one study, researchers measured the bone structure of three generations of women from the same families and found significant correlations in size, thickness, and density of their bones.

What your mother's experience with osteoporosis won't tell you: How strong your bones actually are. A laundry list of environmental factors, from lifestyle habits to health conditions, has a profound effect on bone health. Smoking, high alcohol consumption, and long-term use of certain medications weaken bones. Diabetes and the eating disorders anorexia and bulimia rob bones of key nutrients. Getting plenty of weight-bearing exercise, keeping your weight down, and getting plenty of calcium, magnesium, and vitamin 3 build bone strength even later in life. So just knowing your genetic risk isn't enough; only a bone density test can reveal your bone strength.

4. Whether -- and how soon -- you'll have joint pain

Rheumatoid arthritis, which is an autoimmune disease, has a strong genetic component. If your mother or another first-degree relative has RA, your risk of developing it yourself goes up by 50 percent. Osteoarthritis, the more common type of arthritis, also runs in families, although people with no family history also develop the condition. In osteoarthritis, the protective cartilage at the ends of bones deteriorates, exposing them to friction when you move.

What your mother's diagnosis of rheumatoid arthritis won't tell you: The rest of the story. Carrying excess weight puts pressure on your joints, so if your mother was overweight and you are not (or vice versa), it's important to take that difference into account. Trauma and repetitive stress from work or other activities are common causes of arthritis independent of heredity. Smoking, eating a lot of red meat, and high caffeine intake make you more vulnerable to osteoarthritis, while exercising and stretching regularly can help keep it at bay.

5. Whether you're susceptible to migraines

If your mother was prone to migraine headaches, there's a strong likelihood you'll inherit the same problem, since 70 to 80 percent of the risk is genetic, according to research by neurologist Kate Henry, MD, of New York University, published in *Nature Genetics*. The genetic link is strongest for migraine with aura, in which you see colored or flashing lights or spots just before or during a migraine headache. Migraines are more common in women than in men to begin with, affecting 17 of women but just 8 percent of men.

What your mother's migraine history won't tell you: How frequently you'll get migraines, or how bad they'll be. Migraine frequency, intensity, and duration are affected by a host of factors, including hormonal fluctuations, stress, weight and exercise, and diet and nutrition. Specific migraine triggers are very personal; some people get migraines when they eat chocolate, nuts, cheese, or other foods, while for others it's bright light, strong perfume, and other physical factors that set them off.

(courtesy of MSN.com -- Melanie Haiken, Caring.com senior editor)

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One key benefit of Generations Premium? -- Time with your doctor!

Sunday, 19 November, 2017

When you first heard about Generations Family Practices' new service, Generations Premium, you may have thought to yourself - "Why would I be interested?" Well, to be blunt...you would get more quality time with your family physician. Current policies only allow doctors a certain visit length with their patients before they are no longer reimbursed by the insurance companies. Generations Premium, as a service, by-passes that restriction, increasing your visit from ~15 minutes to an hour plus (if needed). The end result is a better diagnosis, plan-of-care and patient/physician relationship.

Take a moment to read the below blog shared from Kaiser Health News about this subject. If you have questions, please call us. We'd love to hear from you!

"15-Minute Visits Take Toll on Doctor-Patient Relationship"

[This Kaiser Health News story was produced in collaboration with USA Today.]

Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

“He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,” said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.”

These days, stories like Eisenstodt’s are increasingly common. Patients – and physicians – say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements. 

It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes. 

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

“Doctors have one eye on the patient and one eye on the clock,” said David J. Rothman, who studies the history of medicine at Columbia University’s College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.

Shorter visits also increase the likelihood the patient will leave with a prescription for medication, rather than for behavioral change -- like trying to lose a few pounds, or going to the gym.

Physicians don’t like to be rushed either, but for primary care physicians, time is, quite literally, money. Unlike specialists, they don’t do procedures like biopsies or colonoscopies, which generate revenue, but instead, are still paid mostly per visit, with only minor adjustments for those that go longer.

And many doctors may face greater financial pressure as many insurers offering new plans through the health law’s exchanges pay them even less, offering instead to send them large numbers of patients. 

This fee-for-service payment model, which still dominates U.S. health care, rewards doctors who see patients in bulk, said Dr. Reid B. Blackwelder, president of the American Academy of Family Physicians, who practices in Kingsport, Tenn.

“Doctors are thinking, ‘I have to meet my bottom line, pay my overhead, pay my staff and keep my doors open. So it’s a hamster wheel, and they’re seeing more and more patients ... And what ends up happening is the 15-minute visit,” he said.

Struggling For Control

Dr. Richard J. Baron, president of the American Board of Internal Medicine, said that patients and physicians often wrangle over control of that visit – a “struggle for control” over the allocation of time

Sometimes the struggle is overt – as when a patients pulls out a long list of complaints as soon as the doctors comes in.

Sometimes, it’s more subtle. When Judy Weinstein went to see her doctor in Manhattan recently, she knew she would get only 20 minutes with him – even though it was an annual physical, and she had waited nine months for the appointment.

So when the doctor asked if he could have a medical student shadow him, she put her foot down.

“I said, ‘Y’know, I would prefer not. I get 20 minutes of your divided attention as it is – it’s never undivided, ever – and I need to not have any distractions. I need you focused on me.’“

How did visits get so truncated? No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare’s 1992 adoption of a byzantine formula that relies on “relative value units,” or RVUs, to calculate doctors’ fees.

If you must know, the actual formula is: (Work RVU x Geographic Index + Practice Expenses RVU x Geographic Index + Liability Insurance RVU x Geographic Index) x Medicare Conversion Factor.

That was a switch for Medicare, which had previously paid physicians based on prevailing or so-called usual and customary fees. But runaway inflation and widespread inequities dictated a change. RVUs were supposed to take into account the physician’s effort and cost of running a practice, not necessarily how much time he or she spent with patients. 

The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15-minute consult.

Private insurers, in turn, piggybacked on Medicare’s fee schedule, said Princeton health economist Uwe Reinhardt. Then, in the 1990s, he said, “managed care came in and hit doctors with brutal force.”

Doctors who participated in managed care networks had to give insurers discounts on their rates; in exchange, the insurers promised to steer ever more patients their way.

To avoid income cuts, Reinhardt said, “doctors had to see more patients – instead of doing three an hour, they did four.”

Rushed Doctors Listen Less

How doctors structure the precious 15-minute visit varies – often quite dramatically.  Generally, they start by asking the patient how they are and why they came in, trying to zero in on the “chief complaint” -- the medical term for the patient’s primary reason for the visit.

But most patients have more than one issue to discuss, said Dr. Alex Lickerman, an internist who has taught medical students at University of Chicago and is director of the university's Student Health and Counseling Services.

“The patient is thinking: ‘I’m taking the afternoon off work for this appointment. I’ve waited three months for it. I’ve got a list of things to discuss.’

“The doctor is thinking, ‘I’ve got 15 minutes.’ There is almost a built-in tension,” Lickerman said.

Studies show that doctors’ visits have actually not gotten shorter on average in recent decades. The mean time spent with a physician across specialties was 20.8 minutes in 2010, the latest year available, up from 16.3 minutes in 1991-1992 and 18.9 minutes in 2000, according to the National Center for Health Statistics; that includes visits with internists, family docs and pediatricians, which all increased by about two and a half minutes. 

In 1992, most visits – about 70 percent -- lasted 15 minutes or less; by 2010, only half of doctor visits were that short (the data is from the National Ambulatory Medical Care Survey, an annual nationally representative sample survey of visits to physicians).

This doesn’t necessarily mean the patient experience is improving. Medical schools drill students in the art of taking a careful medical history, but studies have found doctors often fall short in the listening department. It turns out they have a bad habit of interrupting.

A 1999 study of 29 family physician practices found that doctors let patients speak for only 23 seconds before redirecting them; only one in four patients got to finish their statement. A University of South Carolina study in 2001 found primary care patients were interrupted after 12 seconds, if not by the health care provider then by a beeper or a knock on the door.

Yet making the patient feel they have been heard may be one of the most important elements of doctoring, Lickerman said.

“People feel dissatisfied when they don’t get a chance to say what they have to say,” he said. “I will sometimes boast that I can make people feel they ‘got their money’s worth’ in five minutes. It’s not the actual time or lack of time people are complaining about – it’s how that time felt.”

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