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A few days ago, a patient of mine came in to refill her medication and to review lab tests that had been taken for her hypertension and type 2 diabetes.
After refilling her prescription and taking her blood pressure readings and other vital signs, we began discussing her recent lab results.
Her A1C — a marker for average blood sugar over a 3-month time period — was elevated to 10.5, an increase from her last reading that was taken three months earlier. For reference, the goal of A1C in a person with type 2 diabetes is 7.0 or less, so her reading indicates that her diabetes is not under control.
On a daily basis, I am expected, as are most nurse practitioners (NPs) in the United States, to spend no more than 15 minutes with patients for a follow-up visit. So while we hadn’t even begun to discuss the potential reasons behind her elevated A1C readings or how to better control her blood sugar, nearly half of her visit was already over.
The visit progressed and we talked about whether she had been checking her blood sugar at home. She had been. Whether she was taking her medications. She was. And whether she was exercising. She didn’t have time. Following the recommended low-carb diet? She was trying.
At this point we had 5 minutes left in her visit.
As a NP, my role as a provider is to diagnose and treat illnesses, but also to provide education that helps people achieve wellness. But what could I really do for my patient in such a short span of time that would both help her to better control her blood sugar and improve her overall health?
This struggle, however, is not an uncommon one. In fact, it’s something I experience every day. And it’s frustrating — not just for me, but for my patients as well.
Despite the data, nurses are constantly at odds with time and staffing numbers
A joint position statement released by the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics, supports the conclusion that people who receive diabetes education better manage their diabetes and overall health.
Moreover, spending more time with patients has been noted to show an improvement in peoples’ overall health outcome — not to mention a reduction in cost in the long run.
Yet while this is the case, NPs are constantly at odds with the amount of time they’re given to spend with their patients. And this is, in part, down to private insurance companies and government programs like Medicare.
While these companies and services don’t dictate how much time can be spent with our patients, they do control how much we as providers — and our practices — get paid for each visit. So if the practice doesn’t see enough patients during the day, they can’t pay the bills.
To make matters worse, there’s currently a shortage of primary care providers in the United States. This, in turn, means there are more patients to be seen by fewer providers each day. And while NPs are trying to fill the gap, it’s not completely closing it.
The best we can do is work within the system we currently have
What, then, to do?
The answer, some would say, is that patients could simply attend special education classes — and in the case of this particular patient, one directed at diabetes education. Or simply book another appointment with me.
But the reality is that she probably wouldn’t do either. And when I broached the subject with her, she told me she simply doesn’t feel as though she can spare any more time, even to improve her health.
As is the case for so many people these days, time for her is at a premium. Yet, given the opportunity, she would happily sit in my office for an extra 15 to 20 minutes since she was already there.
So the question remains: How do we find a balance? One where patients get sufficient face time with their NPs and practices can pay their bills.
Unfortunately, if I’m entirely honest, I don’t foresee our healthcare system changing any time soon. In fact, the shortfall of primary care providers is expected to increase in the coming years, which is likely to put even more of a strain on NPs like myself.
That leaves both the providers and the consumers of healthcare — that’s all of us! — to do the best we can to work within the system.
Working within the system means planning ahead
There are a number of things that both you, the patient, and I the NP can do in order to ensure you’re receiving the treatment you need.
Come prepared for your visit
For you, perhaps the most helpful tip is to arrive at your appointment prepared. This might entail bringing a log of recent blood sugars or a food diary to help pinpoint triggers that lead to heartburn.
This might also mean coming with a short list of concerns or questions. This is personally one of my favorites because I think many of us, myself included, suffer from what I call “medical amnesia.” We know the questions we want to ask at home, and then when we’re in front of our NPs, we blank.
Request, when possible, more time
Finally, if you can, plan further ahead and request a longer appointment time if you think your medical concern merits it.
Providers have a small amount of leeway when it comes to scheduling longer appointments if you provide advance notice and they can spend the time in a way that allows it to be billed.
That said, it’s important to understand that a longer visit could result in having to pay out more, so be mindful of this, depending on your type of insurance coverage.
In return, as the provider, I can try to plan ahead, as well. If I know a patient has concerns that may take more time, I can request a longer visit given enough lead time. I can have handouts prepared related to specific topics for them.
Healthcare is a partnership — one where we all need to be active participants
It’s an ongoing source of frustration and sadness when I think about how much potential there is in our medical system to provide terrific care. Yet the ever expanding rules and regulations created by insurance companies and our government thwart so many of the efforts made by providers.
And while I wish that healthcare was a right granted to every citizen in this country, being realistic, I don’t see this happening any time soon.
Instead, all of us have to work within the existing framework until it changes. This means all patients should view healthcare as a partnership with their providers in which they must be active participants in order to maintain good health and treat existing illnesses successfully.