How should hamsters run? Some observations about sufficient patient time in primary care

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Abstract
In a recent editorial in this journal Ian Morrison and Richard Smith commented on doctors' dissatisfaction with not having sufficient time for their patients and suggested the need to redesign care to better meet the needs of patients.1 Yet to address such a redesign requires a sound factual basis. Although the consensus in the United States has been that managed care has required substantial reductions in the time that patients spend with their doctor, consultation time increased between 1989 and 1998 for prepaid and non-prepaid visits, primary and specialty care, new and repeat visits, and visits for common problems as well as for serious illness.2 Studies of how primary care doctors worked in the United States and in the United Kingdom over the past several decades can contribute to a more refined diagnosis. #### Summary points Doctors in both the United Kingdom and the United States believe that they have less time for each patient, yet time with patients is increasing in both countries Doctors feel stressed because there is now so much more they can do, patients and the public expect more, and there are more external forces impinging on their practice Personal continuity of care between doctor and patient builds trust and allows doctors to use available time more productively Email communication with patients, properly structured and with adequate safeguards, helps maintain continuity of care, provides opportunities to deal expeditiously with routine matters, and allows more time for meaningful communication I have drawn on 35 years of studying medical practice in the United States and United Kingdom, my reprint collection, and searches of Medline and other databases dealing with physician time and uses of the internet for health purposes. In 1966 I surveyed a random sample of 995 general practitioners in England and Wales and asked them about 26 …