Older patients, longer visits

  | June 10, 2016

It's a typical lament, from doctors and patients alike: The all-too-brief visit that leaves little time for empathy or genuine care. But research shows that as patients get older and their cases grow more complex, they are getting more one-on-one time from their physicians.
A study of two million healthcare visits to primary care providers in the athenahealth network found that doctors do, indeed, spend more time with patients as they age — about 20 percent more time with patients 70 and older than with patients in their 30s.
Visit lengths are still relatively short for all ages, ranging from a median time of 11.8 minutes for patients in their 30s and rising to a peak of 14.3 minutes for patients in their 70s or older. And visits aren't substantially longer for patients in their 80s than for patients in their 70s.
But the lengthening visit, for older patients, is part of a national trend, says Stephen Zuckerman, co-director and senior fellow of the Health Policy Center at the Washington, D.C.-based Urban Institute.
“The number of 15-minute visits are going down, and the number of 25-minute visits is going up," Zuckerman says.
Those findings mirror the experience of Peter Basch M.D., a Washington, D.C. -based primary care physician whose patients are mostly over the age of 50.
Basch says every medical procedure takes more time with older patients, including the time it takes to get a patient into the examining room and onto an examining table. He also needs more time to discuss multiple ailments with older patients and to get reticent patients to reveal what's really bothering them, such as depression, anxiety, or stress.
“Older patients rarely come in for one thing," Basch says. “There's a chronic problem being followed by an acute problem and social problems. An adult child often accompanies an aging parent, and may say, 'I'm not sure Mom should be driving anymore.'"
And those multiple ailments take more time to manage, Basch says. It can sometimes take 15 minutes just to evaluate a person's prescription list. His office usually schedules older patients for 20- to 40-minute visits.
It's “hard to tell someone who is older that I only have 15 minutes, and at the same time it's difficult to schedule people who need more time," Basch says.
As the American population ages, that burden might have implications for patient care, says Josh Gray, vice president of research for athenahealth, who oversaw the study of visits to 5,681 primary care physicians at 1,366 practices between October 2013 and September 2015.
Practices that feel burdened by scheduling older patients, Gray wrote in a report, may be more prone to accept patients covered by commercial insurance and “might not feel it is sustainable for them to bring in additional older patients covered by Medicare."
Future studies will examine whether visit times vary with gender, provider types such as nurse practitioners and physician assistants, and patient insurance status.
Already it's clear that when doctors take more time, patients notice.
Margaret Evans, a national security consultant from McLean, Virginia, says her late mother Lois went to doctors' offices “zillions of times" in the seven years that she resided in an assisted living facility.
At one point, Evans took her mother, who suffered from a chronic pulmonary disease, to a geriatric primary care doctor “who was rushed and just didn't take the time to talk to her." So she turned to a pulmonary specialist who became, in effect, Lois's primary care physician — due largely to the fact that, despite the doctor's packed schedule, he was willing to spend extra time with her.
That specialist served as Lois's main doctor for two years before she died in 2013 at the age of 86.
“She would tell him how scared she was and how she couldn't breathe," Evans says. “He talked her down from a place of panic. He would hold her hand, pat her on the shoulder and give her a little kiss."
Judi Hasson is a writer in Washington, D.C.

Older patients, longer visits