e Pharos/Spring 2024 21
The 15-minute patient visit
I read with great interest Dr. Byyny’s article “e
15-minute patient visit: It’s time for a national study,”
(Autumn , pp. 2-8). He helpfully outlines how we got
where we are, and also explains the many negative effects
of our current primary care system. However, he does not
mention one negative effect that may be the most impor-
tant, the moral injury of physicians. It is very difficult to
be forced to do what is wrong (give inadequate attention
to patients, be unable to treat them as human beings, re-
ferring them to high cost specialists or for high cost tests).
Dr. Byyny’s diagnosis is mostly correct: corporatization
and the overall medical-industrial complex have been ma-
jor forces in making primary care medicine unendurable
for patients and physicians alike. Perhaps being profit-
driven is part of the problem, but profit itself is not.
In the summer of 2021, I left a 17-year career in aca-
demic medicine to start a direct primary care practice. I
have never looked back. What makes direct primary care
right for patients is partly that it is free market driven.
Rather than spending my time entering data to allow a
health care system to extract every possible dollar from
health insurance companies by meeting quality indicators,
I do what is best for patients and they are happy to pay a
modest monthly membership fee in return. A simple free
market system produces the best service at the lowest cost,
and always has. When government, insurance companies,
employers, and health care corporations get involved try-
ing to increase value, promote quality and maximize profit,
we end up with patients and doctors serving as pawns in
a game where health care corporations try to persuade
insurance companies to pay them more.
I now schedule mostly one-hour appointments. I have
plenty of time to carefully evaluate each patient’s medical
issues and treat them holistically as a human being. I also
know them personally. If a patient is in a financial bind,
we can work out a solution that allows them to continue
to receive care. Many of my patients are uninsured or
underinsured, working poor or small business owners.
Primary health care is very inexpensive. Removing corpo-
rations, insurance, and the government results in a simple
system that works. Perhaps if I were not human and did
not care about my patients, profit motivation would be a
problem. But, because I want to provide the best care at
the best price, I make a fair profit and can support myself
and my family. I am also experiencing the joy of practic-
ing medicine again!
I don’t think we need a national study to show that 15
minutes is not long enough. We already know. Instead, we
should change the health care payment system to allow
for creative, alternative models like direct primary care to
flourish. en, smart and qualified medical students will
start choosing careers in primary care again, and patients
will have their faith in health care restored.
Steven E. Roskos, MD
AΩA, Michigan State University
East Lansing, MI
ank you for your service to ΑΩΑ and for the edito-
rial on “e 15-minute patient visit...” e editorial was
spot on. We’ve made more than a few sweeping changes
in Medicine over the years based on little or no data and
then have failed to reassess the effects of these changes
relying instead on “e Journal of It Seems to Make
Sense,” or “e Journal of Personal Experience” to guide
our practice of Medicine. Much of the blame, if you will,
falls at our feet for failing to say, “Hey wait a minute. You
can’t do that to my profession!”
Mark R. Milunski, MD, FACC, FACP
AΩA Albany Medical College of Union University, 1982
Orlando, FL
House of Medicine
We read the interesting editorial ”Renewing the com-
mitment to professionalism in the House of Medicine,”
by Drs. Higginbotham and Byyny (Summer , (pp.
2-7). e authors point out that medical professionalism
encompasses trustworthiness, accountability, and com-
mitment to patients and society. A diagram of e House
of Medicine is elegantly shown on the cover. is house
deserves a foundation of health care provider availability.
Hearing soothing words of advice from one’s health care
provider in a timely period to the ailing patient is truly a
foundation of the House of Medicine and a major compo-
nent of caring for patients. In addition, a sense of comfort
is afforded to the patient if they feel that their health
care provider is available should they be needed. is
tenet needs to be continued as a foundation of medicine,
despite recent changes, including health care providers
becoming corporate employees, and having duty shifts.
While availability may change its methodology with ad-
vancing technology, it should remain a foundation of our
House of Medicine.
Jodie A. Barkin, MD, FACG
AΩA, University of Miami Miller School of Medicine
Miami, FL
Jamie S. Barkin, MD, MACP, MACG, FASGE, AGAF, FFGS
AΩA, University of Miami Miller School of Medicine
Miami, FL
Letters to the Editor
