No time for good history-taking

Letter in American Medical News


Letters to the Editor - May 4, 2009

Insurers responsible for time pressures that undermine taking a good medical history
Regarding "Changing history" (AMNews, April 6): It was timely to mention the importance of taking a good history.
Clearly, history taking has taken on a subordinate role, because little time is available time for it. The overuse of lab and imaging studies often fill in as substitutes for engaging patients in their medical narrative, and electronic medical records make it seem that doctors are more interested in data entry than on connecting with patients.
Of the three obstacles to history taking, the time factor is the most critical and the most difficult to resolve. Time is needed for patients and doctors to engage in real dialogue -- not the sorry surrogate forms that patients answer in waiting rooms by checking off what illnesses or surgeries they might have had, or what their marital status is, or whether they smoke.
It could be said that the single greatest wound inflicted by insurance companies on the medical profession is forcing doctors to see more patients than they ought to.
For doctors who want to take a good history and perform the single greatest act that separates medicine from other professions, the only way to get more time is to see fewer patients and practice at a pace that allows good history taking.
This will precipitate a public outcry, but it may be the only way of enlisting public support to wrest control from insurers and put it back into the hands of doctors. Experience has shown that it is impossible to build a humane health system that is dominated by profit-making insurance companies.
--Edward J. Volpintesta, MD, Bethel, Conn.