BMJ  2003;327:E71 (4 October), doi:10.1136/bmjusa.01100005 (published 13 September 2002)

BMJ USA: Letter

RAPID RESPONSES FROM BMJ.COM

Running faster but doing less

This article originally appeared in BMJ USA

Editor—There may be no evidence that we are working harder than our predecessors, but that is because we have dropped a lot of the activities that were undertaken by previous generations of doctors: We no longer do antenatal clinics, postnatal visits, post-op house calls, chronic visits, or even our own acute visits, finding it more efficient for one partner out of four to do all the acute visits on each day. By these means we have managed to preserve the length of our day within manageable proportions and cope with modern demands. But we are still walking a tightrope in each patient encounter by cutting corners, practicing "defensive medicine," and relying on catchall tests. However, it may be that we are running faster as the adrenaline which fuels us is produced in larger volumes as the tightrope gets tighter and higher. Are we caring for people in the way we would wish to be cared for, or are we acceding to the demands for greater throughput?

Stockbridge Surgery, Hampshire, UK adrian.townsend{at}gp-j82016.nhs.uk

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Your statistics missed something

Editor—The science that has found that we have more time to spend with patients sounds preposterous. Has the author been to the doctor himself recently? In the US, where HMOs have saturated the market, the time spent by physicians has not lengthened by any stretch of the imagination. I find such an assertion to be insulting.

University of North Texas Health Science Center, Fort Worth, Texas dostephen{at}spindle.net

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E-mail with patients won't reach the poor and elderly

Editor—I am uncomfortable with Mechanic's proposal that doctors should spend more time consulting by e-mail with their patients. In the UK, internet access is related to socio-economic class; individuals living in a household headed by someone in a routine or semi-routine occupation access the internet less frequently than do those living in households headed by someone in a managerial or professional occupation (68% to 87% vs 23% to 36%, respectively, in a one-month period). Although computer ownership has increased in the UK from 18% in 1988 to 34% in 1998/9, certain groups are less likely to own computers. The most important of these groups are persons aged 60 and over (4% ownership in 1998/9). It seems likely that Mechanic's proposed solution may marginalize the old and the poor in favor of the more youthful and socio-economically advantaged.

London, UK g.wong{at}pcps.ucl.ac.uk.

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