Time remains one of the most critical elements in providing high-quality care for older patients. This seems intuitive: decisions are often complex, family members are frequently involved, and aging-related impairments themselves (such as difficulty hearing) may hinder communication. Despite this, clinicians face enormous pressures to make visits shorter in order to maximize volume, even with complicated older patients.
So I was intrigued by a recent Perspective piece in New England Journal of Medicine which argued that, aside from being the right thing to do, spending more time with patients can actually be cost-effective. The authors illustrated several cases where detailed conversations can avoid extensive downstream healthcare costs – for example, a prolonged anticipatory discussion about dialysis planning ($200) can markedly reduce the likelihood of complications from hastily placed dialysis catheters ($20,000). As another example, a multidisciplinary oncology conference among experts that spent 5 minutes per patient changed treatment plans nearly one-third of the time, potentially avoiding improper (and expensive) downstream care.
I think these studies underscore what many patients and clinicians intuitively know: that time is one of our most valuable resources. Moving forward, it will be interesting to see whether the “value” of these conversations increases, especially when caring for older adults, as the evidence keeps accumulating and we move towards new models of reimbursement.
By: John Dodson, MD
aginghearts.org 