Let’s save our doctors’ time for patients

Are doctors overwhelmed by busy work, so they don’t get much time to help people? If you read no further, this is the crux of my argument.

Friends ask if I have a family doctor. I acknowledge that Dr. C has been my doctor for two decades. He inherited it after my old school doctor retired. While they think I am lucky, in truth he is a stranger in my life.

For 20 years I have seen him once a year for very short consultations, (usually to request an x-ray to see if I broke something after falling off my motorcycle). In every visit I have noticed a certain tendency: he wants to give me more than he wants. He wonders about my cholesterol or my blood sugar, a colon exam, a prostate exam, or a flu shot. I’m polite every time I say, I’ll look at those things and come back to it.

I never do. why? Because I’ve already looked at these things and there’s basically no interest there. I am a healthy, fit, 60-year-old man who has spent 30 years studying the value of medical technologies, pharmaceuticals, and screening tests, and the prevention rewards they offer are theoretically sound, but in my opinion, less by intervention than by the things that turn healthy people into patients. Of course, call me a skeptic, but such busywork does not contribute to the length and quality of my life. I have read many large studies of major classes of drugs and analyzed medical screening evidence, enough to write books on this stuff. I am good at refusing more medicine than I need.

Like most doctors, however, he’s just being proactive, looking for signs of illness before it hits me. I get it. But it makes me think: where does he find time to help people who are really sick?

Here’s the brutal truth about prevention for health policymakers and others: If our doctors are too busy offering low-value prevention to healthy people, they won’t be available to real patients. This is not rude. It is a fundamental allocation of resources informed by evidence about benefits, harms and opportunity costs.

Large trials and systematic reviews have repeatedly shown that many screening tests and preventive prescriptions achieve little benefit for otherwise healthy individuals while often introducing real harm. Screening that looks good on paper can lead to false positives, more tests, overdiagnosis, anxiety, and procedures that don’t improve—and sometimes worsen—the quality or length of our lives. Every medicine comes with some kind of harm. Consider your chances with these disadvantages if you have a serious need, sure. But what if you’re already otherwise healthy?

Drugs prescribed for healthy people often have little benefit. Lower your cholesterol? Sure, if you think that the 2% reduction in heart attack risk (and the potential risk of muscle weakness that comes with it) for taking the pill daily for 10 years is worth it. An osteoporosis drug that produces a 1% reduction in hip fracture risk? Then there is the problem of overmedication of the elderly, a particularly common form of abuse in our elderly population that leads to high rates of hospitalization and death. Millions of other healthy people are labeled “at risk,” suffer adverse drug effects, and waste our doctors’ time (and our health care dollars) that could be devoted to more serious problems.

Like many physicians, Dr. C avoids “prevention” because it’s clean, feels functional, and aligns with the performance metrics and billing incentives of working in a system that rewards overwork rather than overwork. But is that time being stolen from more urgent cases: the frail patient with many things going wrong at once, the one with new, unexplained symptoms, or the one requiring complex coordination for a mother who is rapidly failing? For those moments when we need the experienced clinical judgment, consistency, and steady hand of a doctor, our doctors’ time never seems to be enough.

The policy must acknowledge two truths. First, prevention is not always good, or even worth the trouble. It’s really only useful when targeting people at a sufficiently high baseline risk where the absolute benefit outweighs the harm. Second, primary care capacity is limited. Feeding with low-yield interventions limits the ability to manage emergency and complex care.

What would a sensible approach look like? Our health systems must establish clear, evidence-based thresholds for prescribing screening or primary prevention drugs—thresholds based on absolute risk, life expectancy, and patient values. Let’s stop the nasty electronic medical guidelines that push so many unnecessary tests on healthy people like me. This expensive busy work has to go. We can’t stand it.

Second, physicians and the general public need honest education about the risks and benefits that come with health care. Not every visit to a specialist is the end of your problems. This may just be the beginning. People need to reject the “prevention is better” propaganda and start questioning the people who sell them drugs and the theory of “primary treatment” that cares most about healthy people.

People will accuse me of being cold-hearted or “preventive.” I’m not either. Deterrence only makes sense when applied where it matters, not for whom the balance of benefits and harms is significant. We can have both prevention and capacity–only if we return patients to our physician’s care center.