CardioExchange Archive

As the doctor begins to talk to his patient about smoking cessation, he receives the first “rescue” page. He immediately knows that he has violated — again — the 15-minute-per-patient rule, a rule that surprisingly even patients in the waiting area expect their doctors to follow. Nurses, administrators, and patients coalesce into one giant chronometer, timing every move the doctor makes. We are living in a time-efficiency era in medicine — nothing wrong with that if we provide good care. 

The rescue page serves a crucial function in today’s health care delivery system. It is an exit strategy, giving the physician an excuse to end the session and avoid wasteful practices (like talking to patients about disease prevention) that generate more headaches than profit for the clinic. The rescue page is analogous to the psychiatrist’s clock in a Hollywood movie, helping patients recognize the end of a session. “Time’s up … we’ll continue discussing your suicidal ideation next week.” 

The doctor continues to discuss the risks of smoking and describe cessation strategies. “Beep…beep…beep!” A second rescue page interrupts the conversation. This time, it reads “S.O.S.” The doctor is under pressure, and the patient is becoming uncomfortable, feeling unworthy of the doctor’s time. By the time the pager stops beeping, both patient and doctor want to end the session. A third rescue page would be too much. Shared dissatisfaction is unavoidable. 

The next patient enters, an obese 50-year-old man complaining of chest pain. The physician can tell that this patient is a talker and fears another rescue page situation. Determined to keep to 15 minutes, he repeatedly interrupts the man’s efforts to describe his symptoms. The patient awkwardly answers, as the doctor-turned-prosecutor fires question after question, trying to stick to the script. After a useless 10-minute interrogation and a pitiful physical examination, the doctor makes the decision the system expects. He replaces words with orders for a battery of tests. As his patient sets off on the not uncommon path of possibly unnecessary testing and potentially avoidable complications, the doctor glumly contemplates his efficiency. If only he would have listened… 

The rescue page reflects the shortsighted priorities imposed by a system that reimburses aggressive and invasive strategies, promotes quantity over quality, and limits disease prevention and lifestyle counseling. The beeping of the rescue page should remind us how this system directly influences patient care and the doctor-patient relationship.