Doctors aren’t talking to patients about what’s most likely to kill them

Male doctor in white lab coat
It's not that patients don't want to talk to patients about issues, they don't have the time. (Getty/Saklakova)

Primary care doctors are neglecting to talk to patients about the things that are most likely to kill them, according to a recent survey.

The survey of 3,000 Americans by ImagineMD, a direct primary care medical practice in Chicago, found few doctors are talking to patients about issues such as drug overdose, suicide and traffic accidents—some of the leading causes of death in America.

The practice did the survey to look at whether doctors are adequately addressing key issues with their patients.

Among the results:

  • 9 in 10 doctors never ask about opioid abuse
  • Less than 20% adequately inquire about patients’ mental health
  • Less than 10% talk about preventative health measures related to driving, such as always wearing seat belts

“I wasn’t at all surprised by the results,” said Alex Lickerman, M.D., the founder and CEO of ImagineMD, in an interview with Fierce Healthcare.

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It’s not that doctors don’t want to have those conversations, they just don’t have enough time to spend with their patients, Lickerman said. It’s why he left the University of Chicago in 2016 after 20 years working there to start his own direct care practice.

But his study raises questions about the consequences of rushed doctor visits. The average doctor visit lasts just over 15 minutes, with the median time for doctors to talk to patients at just over 5 minutes, Lickerman said.
Alex Lickerman
Alex Lickerman, M.D. (ImagineMD)

The survey divided responses into two groups—those ages 15 to 44 and those from 45 to 64 and focused on the most preventable causes of death. Patients were asked what topics their doctors raised in conversations with them and to what degree.

The Centers for Disease Control and Prevention said the leading cause of death for those younger patients is poisonings or drug overdoses, followed by suicide and traffic accidents.

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Even though the opioid crisis has been a national epidemic, with overdoses killing an estimated 115 people in the U.S. each day, the study found fewer than one in 10 people said their doctors raised the topic with them.

For those aged 45 to 64, coronary heart disease is the leading cause of death, yet the survey found only 40% of patients said doctors talked to them about stress.

“There’s a lot we can do,” Lickerman said about talking to patients about issues that have a great impact on their health.  The trouble is “those conversations are not five-minute conversations.”

Too many patients, too little time

So, doctors who ask patients about mental health issues, such as depression or anxiety, may find themselves opening a Pandora’s Box. Such a conversation can put doctors five patients behind, so many would rather not ask, he said.

And Lickerman said he doesn’t see that changing under the existing system. Reimbursements are so low that doctors can’t afford to start cutting their patient load, he said. But just as some experts advise patients wanting to make the most of their limited time with a doctor to decide what questions are most important, doctors can use a similar strategy.

Lickerman said doctors, who are seeing perhaps 20 to 24 patients a day, can review a patient’s chart before an office visit and make a short list of what they want to discuss and use that as a starting point. “Doctors can prioritize. It doesn’t mean we get to everything in fee-for-service medicine,” he said. Another solution is to bring in coaches, who can work with patients to change behaviors, such as smoking, exercising and dieting, he said.

Direct care was his solution

But Lickerman, 51, said the real solution for him and for an increasing number of physicians is to switch to direct care practice. His Chicago-based practice charges patients a monthly membership fee of $149 and does not accept insurance. But it gives him time with patients.

“I just love medicine. I just love to take care of people,” he said. While a doctor in a traditional practice will have around 2,500 patients, doctors in his practice have a maximum of 600 patients. “That’s the secret sauce.” Patients have a two-hour initial appointment and thereafter appointments are scheduled for an hour but can last longer. Doctors see six patients a day.

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He said he contemplated opening a direct care practice 10 years ago but did not think the system was ready for it. “Now I think it’s begging for it,” he said.

Lickerman hopes to open two other offices in the Chicago suburbs this fall and is looking at opening offices in seven other locations across the country. “We want to create a culture. We want to be the Four Seasons of healthcare—where doctors know you and care about you,” he said.

He doesn’t think he will have trouble finding doctors. “All primary care doctors are feeling they want to get off the treadmill,” he said.