A primary care prevention revolution?

Dear Sir or Madame:

I’m not sure where the number “18 hours per day” came from: the only referenced article claims that in 2003, American physicians needed to spend 7.4 hours per working day to “fully satisfy the USPSTF recommendations”.

This was in the US, and in an era before implementation of “Choosing Wisely", which I remember well: annual Pap tests, bimanual exams, and breast exams for all females over age 14 requesting oral contraception (no pap test -- > no birth control pills, good God!) ;annual prostate cancer screening; doing annual blood stool occult blood screening in my office (remember the 5 minutes spent waiting to measure the blue zone which expanded around each tablet after a few drops of water were added ?); bringing patients back every few months for physician performed blood pressure checks (before invention of automated BP machines); etc etc. What a lot of wasted time and needless embarrassment for patients, not to mention iatrogenesis! And there were no nurse practitioners or other allied health colleagues to whom we could delegate.

I posit that I now spend much less than 7,4 hours a day attending to prevention, and way more time than I did in the 1990’s managing ever more numerous co-morbidities. Who can name all the medications used to treat diabetes, or all the inhalers used to treat COPD? I almost never ordered infiltrations (shoulders, spines, hips, knees) in the 1980’s, and now I order several per week. Don’t get me started on all the medications being used, with little effect, for chronic pain! (Actually, yes, please get me started, chronic pain has become one of my interests.)

I actually think that the time I save on avoiding useless, dangerous, and embarassing preventive interventions is now wasted on the many hours I spend scouring electronic medical records, of which I usually have 4 (four) open at all times.

So whicle I agree that medical practice has certainly been revolutionized since my graduation in 1984, I feel that prevention has diminished as the drain on time management which it was previously.

Steve DiTommaso, MD

An avid reader and unabashed admirer of "Canadian Family Physcian"
Montreal