In the brave new world spawned by managed care, patients are a virtue. Patience is a luxury. Though physicians and other providers may try their best to take the time to get to know and thoroughly treat each patient, the reality is that time is money and the clock is always ticking. All the while, the miserly overseers (HMO erectus) loom in the background tapping their gold pocket watches and mentally calculating the profits from the Factory Pharm. What a mess!
From the New York Times:
Study Questions Colonoscopy Effectiveness
For years, patients and many doctors assumed that a colonoscopy was a colonoscopy. Patients who had one seldom questioned how well it was done. The expectation was that the doctor conducting the exam would find and cut out any polyps, which are the source of most colon cancer.
But a new study, published today in The New England Journal of Medicine, provides a graphic illustration of how wrong that assumption can be, gastroenterologists say. The study, of 12 highly experienced board-certified gastroenterologists in private practice, found some were 10 times better than others at finding adenomas, the polyps that can turn into cancer.
One factor distinguishing the physicians who found many adenomas from those who found few was the amount of time spent examining the colon, according to the study, in which the gastroenterologists kept track of the time for each exam and how many polyps they found.
They discovered that those who slowed down and took their time found more polyps.
“We were all experienced colonoscopists,� said Dr. Robert L. Barclay, a member of the group that participated in the study, Rockford Gastroenterology Associates in Rockford, Ill. “We had each done 3,000 or more colonoscopies before the study.�
Yet, Dr. Barclay added, “if our group is representative of an average group, you will see people who take 2 or 3 minutes and people who take 20 minutes� to examine a colon. Insurers pay doctors the same no matter how much time they spend. Gastroenterologists say colonoscopies can help prevent colon cancer, but warn that there is a pressing need for better quality control. [full text]
Kmareka.com 
in most areas of health care it’s a liability to be slow. you get flack from your peers and you get paid less. but some of us are slow and careful and there is a place for that kind of practice. it makes sense that a doctor who spends more time will see something another one would have missed, but the system is so money-driven that no one wants to admit that. the same logic is what you hear when they cut nursing staff and claim that everyone will get the same quality of care, in fact better, now that we have fewer skilled people to do the work. in less time.