After spending the last few months getting ready for a large accreditation survey for our hospital, and having survived the last week with all the surveyors on campus looking into every nook and cranny, it’s made us rethink how we do things, how we need to work to be so much better, and how hard it is to do what we are already doing.

It seems that over the course of the past few decades, the number of things that have to happen at a medical office visit — that are expected to be done and completed and checked on — has grown so exponentially that none of us can fathom getting through it all.

Many years ago, a study suggested that primary care office visits would take 4 hours per patient if we actually just got through all of the issues that needed to be addressed with an average patient.

Since then, because of greater recognition on our part about what true health entails, as well as things often not within our control, more and more tasks have been layered onto the office visit, and the responsibility for getting them done has fallen primarily at the feet of those practicing in primary care settings.

There’s the requirement that we ask about pain at every office visit, and document whether this has improved or worsened from the last visit. There’s the requirement that we ask about smoking, and what we are going to do about it.

We need to update and reconcile medication lists at every office visit, a laborious and time intensive (although critically needed), task to safely care for patients. We have to ask about a patient’s fall risk, whether patients are safe in their homes, whether they’re depressed or suicidal, whether they have access to healthy food and affordable housing.

And all of this is before we even get to issues uncovered by our patient’s symptoms and complaints, a thorough but relevant review of systems, our physical examination, and the management of their general health conditions.

It’s no surprise that doctors are burned out, that the huge load of tasks that falls squarely on our shoulders has been weighing us down more heavily. And no wonder that we are finishing notes in our pajamas at night, and answering portal messages all weekend.

It’s not that we don’t want to take care of all this stuff, we recognize this is in fact critically important to getting our patients as healthy as they can be. It’s just that we are often left feeling like we’re all alone out here, that all these mandated things that need to be asked and answered should be recognized as requiring an enormous amount of work, the kind of work that leaves you physically and mentally exhausted and drained.

We want to be here for patients, but if we are going to do this right, we are going to need a lot of help.

The true model of a patient-centered medical home calls for the care of the patient to extend far beyond the confines and limited time of the office visit, and this includes more than just token phone calls documenting outreach to a patient.

We need a vast array of people helping us out, helping our patients, assessing and addressing their needs, and working creatively together as a team to find solutions.

This can be done for so many things, in so many creative ways, if we just have the will, and take the time.

Telehealth support, interim video visits with other team members, pharmacists managing medication issues and compliance, social workers and community organizers connecting patients to resources, and so much more.

One of the items that was flagged during the recent visit from the surveyors was the poor documentation of the use of medical interpreters for office visits in those patients who had a language other than English listed as their preferred language.

Just a few weeks ago, when I was seeing a patient of mine I’ve taken care of for over 2 decades, I noticed on the masthead of her chart that Spanish was listed as her preferred language.

I asked her, and her son who was with her that day, if this was true, if she felt more comfortable in any way using a medical translator, and had I somehow been neglecting this need of hers, forcing her to get suboptimal care due to my lack of fluency?

She laughed, as did her son.

They both said that while Spanish was her native language, that they all spoke English around the house, and she never expected or wanted to get her medical care in Spanish.

Apparently, the regulations require that we not only document when there is language discordance between the patient and the provider that the patient has been offered a medical translator, but that if they decline then we are supposed to additionally add on that they have been educated about the benefits of using this translator service even if they say they don’t want it.

At this point, nearly half of our office visit time would be used up, and we would never get to the taking care of that so desperately needs to happen.

Whenever patients come to us and say they want a family member or friend to translate, we make sure we let them know that translator services are always available, that they do not need to rely on someone they know to provide translator services, and will even go so far as to ask this other person to leave the room, and using a telephone translator ask the patient if there’s anything they wanted to talk about today that they didn’t feel comfortable speaking about in front of that other person.

More than anything else, I think this gives patients the comfort of knowing that this is a place where they can safely get care, and talk about anything securely and privately.

There’s got to be ways to build this type of functionality into the electronic medical record, to prompt us that the patient has a language preference stated as something other than what we speak.

And someone at registration, or when the patient joins the online portal, goes through this and verifies with the patient whether they want a translator present for their examination or not.

For each and every thing that we have to ask about, and document, and click checkboxes for, there needs to be a team of skilled professionals standing by ready to help us overcome the obstacles that our patients face.

We were trained to take care of diabetes, heart failure, arthritis, asthma, depression, and so much more. And we clearly recognize that so much more goes into the health of our patients than just ordering tests and prescribing medicines and placing referrals.

To take care of the whole patient, we need more help, both to make the jobs that we have to do easier, and to extend the spectrum of what we can do.

The care of the patient today has become so much more complex, and the bureaucracy and regulations that have built up around it have only intensified the pressure on those trying to get things done for our patients.

So, perhaps the experience of going through this accreditation will amplify our calls for help, and hopefully the powers that be, the people behind the scenes who make the decisions about how to staff our practices, will hear our pleas and come along with offers of help.

Time is short.

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine from the perspective of his own practice.

Last Updated August 02, 2021