Patient time 

Anyone who’s a patient in an ambulatory setting can attest that the time spent receiving health care is often much greater than the time they’re face-to-face with a clinician. There’s the time traveling to appointments, time in the waiting room, and time receiving recommended labs, imaging, procedures, and treatments. All of this adds up, yet the total time burden may be difficult for clinicians to appreciate during an isolated encounter with a patient.  

It also may be hard to assess the value of that time to the patient and their care partners who accompany them. For example, patients who miss work while engaging with the health care system might forgo essential wages, while others may spend money or social capital to secure childcare at the time of their appointments. For other patients, the opportunity cost of time spent may be more abstract, like days taken away from people that they love or doing activities that bring them meaning or joy.   

In response to the need to quantify this burden on patients, health services researchers recently developed the measure “healthcare contact days,” defined as days spent getting healthcare outside the home. Initial studies employing this measure have shown that older adults on traditional Medicare spend on average three weeks a year receiving healthcare and that those with dementia spend even more. A study quantifying time spent by patients with cancer estimated that the average time to attend a clinic visit was over two hours, while completing labs took over an hour and a half.

In the future, health care contact days might be used as a metric to guide policies and in cost-benefit calculations when evaluating new tests and therapeutics; in the meantime, there are practical steps that individual clinicians and health systems can take to reduce the burden of time on patients. If patients report being burdened by the time they’re spending receiving care, consider the following actions outlined in this recent NEJM Perspective: 

1. Include time as a factor in addition to efficacy and affordability in shared decision-making conversations about diagnostic workups and treatment plans. 

2. Arrange for patients to have necessary procedures, treatments, labs, and imaging performed on the same day as office visits. 

 3. Coordinate appointments located in the same building/area to be scheduled on the same day. 

4. When clinically appropriate, offer patients the option of telemedicine visits and remote monitoring, for example home blood pressure cuffs.  

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.