Parents, especially brand-new ones, are full of questions. How long should baby sleep? When should he start rolling over, sitting up, cooing? What about naps — when and how often? It would be nice to spend a leisurely hour with the pediatrician, getting all the answers, but one-third of parents say well-visit check-ups last less than 10 minutes, according to new research published Monday in the journal Pediatrics.
Perhaps even more surprising is that just half of those short visits included a developmental assessment, which is frequently the main reason for well-child visits. Most surprising of all, though, is that most parents reported high levels of satisfaction even with an in-and-out doctor visits, indicating either that pediatricians are doing a good job covering a lot of ground in little time or that parents don’t know to expect otherwise.
“Lots of market forces require you do as much as you can in as little time as possible,” says Neal Halfon, lead author and director of the Center for Healthier Children, Families and Communities at the University of California, Los Angeles (UCLA). “One might wonder that some people find an under-10-minute visit very satisfying, but perhaps they’re not looking for the Marcus Welby moment. Or they might not know any different.”
When my children were babies — and afterward — the actual physical, hands-on segment of the doctor visit amounted to no more than a couple minutes. Hearing the doc pronounce my child “perfect” always made me smile, of course, but the real value in the 20 to 30 minutes he spent with me was in the education I received. Probably because I’m a journalist, I always arrived armed with a list of questions, which he always took the time to answer fully.
But that kind of attention seems uncommon, according to the Pediatrics study. Researchers asked the parents of nearly 2,000 babies and toddlers to describe their child’s last check-up: how long it lasted and what topics the doctor covered, including immunizations, breast-feeding, injury prevention, developmental milestones and psychosocial issues. They also looked at parents’ overall satisfaction with the visits and whether they felt the care was “family-centered,” which means that parents felt doctors recognized their authority.
A third of parents indicated that doctors spent less than 10 minutes with them, 47% reported visits lasting between 11 to 20 minutes and 20% said their visits were at least 21 minutes long.
Not surprisingly, parents reported less “family-centered” care and fewer preventive-care discussions during the shorter visits. There’s a huge push in medical care to emphasize prevention — teaching kids to exercise and eat well when they’re young, for example, rather than waiting until adolescence to treat obesity — but the Pediatrics research shows that demands on physicians’ time are restricting their ability to emphasize preventive care or delve into dicier topics.
Even what many pediatricians consider critical developmental assessments are falling by the wayside: they are performed just 70% of the time in the longest visits and only half of the time during the shortest visits. Isn’t the whole point of a well-child visit to determine whether kids are meeting developmental milestones? “One would think,” says Halfon, who is also a professor of pediatrics at UCLA.
But for many children who are not as privileged as mine, developmental assessments may not be top priority; just getting adequate nutrition into a low-income child is often the primary focus.
Still, the more time doctors can spend with patients, the more topics they’re able to discuss — including psychosocial and developmental issues, such as getting along with other kids and relating to siblings. During longer visits, doctors were also more likely to address psychosocial risk factors such as alcohol use at home or family violence, the study found.
“It’s intuitive,” says Halfon. “As a pediatrician, if you know you have only 10 minutes, you’re not going to open up a topic that potentially deserves exploration and sensitive interaction if you have one foot out the door.”
At the shorter visits, doctors tended to hit the high points — immunizations, breast-feeding — and cover other issues as time allowed. Yet although longer doctor visits yielded higher satisfaction levels, parents were also pleased with the material covered in the shortest visits. Longer visits were associated with more time to discuss more topics, but 82% of those who spent the least time with the doctor said they were “very satisfied”; for those who spent the most time, the proportion rose to 91%.
In the shortest-visit group, 89% of parents said they were able to ask all their questions, compared with 99% of parents in the longest-visit group.
And, in perhaps the most telling indicator of satisfaction, researchers found that a majority of parents in all groups would recommend their pediatrician to others — 73% of parents who reported the shortest visits and 85% of those who spent the most time with the doctor.