One Or Two Complaints

Have you ever sought medical attention only to be told that your visit is limited to an

arbitrary number of concerns, aka “complaints”? What gives?

My initial reaction upon hearing of this two-complaint phenomenon was diagnostic: how

do you know that complaints three and four aren’t going to shed light on complaints one

and two? After all, many diseases affect multiple organ systems. One of the classic

ones which every medical student learns of is Reiter’s Syndrome, or reactive arthritis,

whose mnemonic goes “can’t pee, can’t see, can’t climb a tree.” Now maybe when a

patient tells me they are having burning when they urinate I think to inquire about their

joints rather than jump to thoughts of urinary tract infections and sexually transmitted

diseases, but it’s a whole lot nicer for the patient to be able to volunteer that their getting

a lot of pink eye, and by the way, their joints are hurting. Or more likely the patient is

suffering from high blood pressure, and upon further discussion it is apparent that this

hypertension is connected to sleep apnea and insulin resistance. Many diseases are not

distinct entities.

So why the artificial constraints on patient complaints? The answer is two-fold: time and

cognitive bandwidth. The average primary care physician is seeing 3+ patients per hour.

That’s 20 minutes per slot, during which they must not only address the patient’s

concerns, but document, and wrap up the encounter, lest they are still documenting well

into the evening on patients they saw hours ago. Data entry takes up a large portion of

a physician’s time, because documentation is how the practice gets paid. And if you

only have 5-10 minutes of face time during an encounter, the added complexity of

another complaint is how you run out of time.

Is there any way around this? Unfortunately not in the traditional insurance based

model. Something has to give. Either visits run longer, or patients need to return for

additional visits to say what’s on their mind. And longer visits aren’t compensated by

insurance, so it’s additional visits for the patient which are likely to be deferred into the

far future. Patients get frustrated, and physicians get burned out from practicing

medicine the wrong way.

A concierge practice doesn’t have these constraints. I spend at least an hour and a half

with patients when they onboard precisely so we have adequate time for as many

concerns as you have. I can’t stomach the thought of going back to “factory medicine”,

and neither should you.