We Don't Have 27 Hours In A Day, Physicians Remind Guideline-Makers


By Erica Carbajal 

It may not come as a surprise that in today's healthcare landscape, there's simply not enough time in the day for physicians to provide guideline-recommended care. As a result, many physicians want time and usefulness to be considered in the creation of guidelines.

Last August, a study made an astounding estimate: It would take nearly 27 hours a day for primary care physicians to provide guideline-recommended care for an average number of patients. Take away the recommended chronic and acute care as well as administrative work, and physicians would still need 8.6 hours per day just to follow the preventive care checklist recommended by the U.S. Preventive Services Task Force.

"A lot of guidelines may seem reasonable when considered in isolation," said Dr. Minna Johansson, a general practitioner in Sweden. "But the cumulative burden of all guideline recommendations combined is absurd." Dr. Johansson has studied the matter with researchers from the U.S. and Canada, who say the issue affects medical systems across North America and Western Europe.

While physicians recognize the good intent behind care recommendations, they argue that some guidelines that lack evidence to long-term health improvements could be scrapped.

In the U.S., physicians aren't expected to check off every guideline recommendation in a single visit, according to the USPSTF.

"Clinicians do not — and would never be expected to — implement all of the suggested screenings, counseling services, and preventive medications in a single visit," said Carol Mangione, MD, chair of the task force, adding the task force does consider time when developing guidelines. "When caring for patients, clinicians use both their judgment and the information obtained during conversations with each patient to prioritize which preventive services should be offered during each visit," she said.

Still, "Deciding what to prioritize in a busy primary care practice is a big challenge," Daniel Jonas, MD, director of the division of general internal medicine at the Ohio State University in Columbus.


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    • Editor-in Chief:
    • Theodore Massey
    • Editor:
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      Lin Takahashi
      Thomas Levine
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      Lisa Andonis

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