【英语国际】美国医疗体系老大难：看病慢

Of all the problems with the U.S. health-care system, one of the most vexing for patients is simply sitting in the doctor's waiting room. Being ushered into the exam room, only to be left shivering in a paper gown, to wait some more, adds to the aggravation. It's the health-care equivalent of being stuck on the tarmac in a crowded plane.

The average time patients spend waiting to see a health-care provider is 22 minutes, and some waits stretch for hours, according to a 2009 report by Press Ganey Associates, a health-care consulting firm, which surveyed 2.4 million patients at more than 10,000 locations. Orthopedists have the longest waits, at 29 minutes; dermatologists the shortest, at 20. The report also noted that patient satisfaction dropped significantly with each five minutes of waiting time.

Physicians rightly bristle that they aren't serving french fries. Patients are different, and their needs are unpredictable. What's more, doctors say that fee-for-service medicine with low reimbursement rates forces them to keep packing more patients into each day, compounding the opportunity for delays.

'I live my life in seven-minute intervals,' says Laurie Green, a obstetrician-gynecologist in San Francisco who delivers 400 to 500 babies a year and says she needs to bring in $70 every 15 minutes just to meet her office overhead.

Some practices, like Dr. Green's, pride themselves on running efficiently, and others are finding ways to streamline office-traffic flow and cut waiting time. 'Patients' time is valuable. I think practitioners understand that more and more,' says Andre W. Renna, executive director of a group of 14 gastroenterologists in Lancaster, Pa. He says even the term 'waiting room' has a bad connotation. Many offices prefer 'reception area' instead.

Some steps to reduce patient wait times are as simple as leaving a few 'catch-up' slots empty each day or stocking the same supplies in the same place in every exam room. 'That way, doctors don't have to stick their heads out the door and ask where things are. It saves a lot of time,' says L. Gordon Moore, a family physician and faculty member of the Institute for Healthcare Improvement, a Cambridge, Mass.-based non-profit group that advises medical practices.

Cutting waiting times is also part of the movement toward turning primary-care practices into what reformers call 'patient-centered medical homes.'

For now, patients themselves can minimize waits by asking for the first appointment of the day or right after lunch, when doctors are least likely to be backed up.

Melinda Beck

在美国医疗体系的诸多问题中，最令病人头疼的问题之一就是坐在医生的候诊室中等待。病人被叫到诊疗室以后，还得抖抖索索地钻进一袭纸袍，等着做更多检查，这更加剧了痛苦。看病就相当于被塞进一架拥挤不堪的飞机中。

Associated Press美国一家医院的公告牌。医疗咨询公司Press Ganey Associates在10,000多个地点调查了240万位病人，并于2009年发布了一份报告，根据这份报告，病人看病时花在等待上的时间平均为22分钟，有些人要等数小时之久。看骨科等的时间最久，要花29分钟；看皮肤科等的时间最短，要花20分钟。该报告还指出，每多等5分钟，病人的满意度就会明显下降。

医生们振振有词地反驳道，他们不是在卖炸薯条。病人们情况各异，而他们的需求难以预测。此外，医生们还说，低补偿率下以量计酬的医疗制度迫使他们每天要看更多病人，这增加了延长候诊时间的可能。

“我的生活以七分钟为一个间隔”，旧金山市（San Francisco）的妇产科医生格林（Laurie Green）说。她每年要接生400──500个婴儿，她说她需要每15分钟挣70美元才刚好能弥补办公室管理费用。

有些诊所──例如格林医生的诊所──以诊疗效率高而自豪，也有些诊所找到了提高诊疗高峰期效率、减少候诊时间的方法。“病人的时间很宝贵。我认为执业医师越来越明白这点”，伦纳（Andre W. Renna）说。他是宾夕法尼亚州兰开斯特（Lancaster）一家医师组织的执行总监，这家组织由14名肠胃科医生组成。他说，即使是“候诊室”这个词的含义也有问题。许多办公室都更愿意用“接待区”这个词。

有些减少病人候诊时间的步骤很简单，比如每天留出一些“加诊”时段，或者在每间诊疗室中的相同位置都放上相同的医疗器械。“这样医生们就不用再把头伸出门，问东西放在哪里。这省去了许多时间”，穆尔（L. Gordon Moore）说。他是一名家庭医生，也是医疗改善协会（Institute for Healthcare Improvement，一家位于马萨诸塞州剑桥（Cambridge），为诊所提供咨询服务的非营利组织）的职员。

减少候诊时间也是将初级诊所转变为改革者们所称的“以病人为中心的医疗之家”行动的一部分。

现在，当医生们拖拖拉拉不愿行动时，病人自己可以要求在白天第一个看病或在午饭后马上看病，借此减少候诊时间。

Melinda Beck

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