Many commentators over the years have lamented the “tyranny” of the brief office visit. The urgency of patient problems, the short duration of office visits and the tendency of clinicians to talk far more than they listen leaves little time for human interaction, much less preventive care and routine chronic illness management. Rushed, problem-oriented visits have been implicated as a major reason that roughly one-half of Americans with chronic illness are not receiving effective care.¹ In addition to negative impacts on the process of care, substantial percentages of American sicker adults report that their doctors do not answer their important questions (24%), do not tell them about their treatment or ask their opinions (50%), and do not make treatment goals clear (27%).² These data help explain the observation that chronically ill individuals report lower satisfaction with care than do others and that, among individuals with a specific condition such as diabetes, satisfaction declines with increasing severity of illness.³ Respondents in other developed nations report somewhat better communication, but not by much.

Patients are not the only ones frustrated. The daily grind of a relentless series of these brief encounters contributes to the growing dissatisfaction of American primary care doctors, who, unlike some of their European counterparts, rarely see patients …