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Recent Surveys Find Doctors Are Logging More Time With Patients

January 22, 2001|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

A common complaint from doctors these days is that they are being pressured to see more patients during the day, leading to shorter, rushed office visits--and ultimately, to diminished quality of medical care. But a new study suggests that doctors are spending a little more, not less, time with patients than they did a few years ago.

Using two surveys, one by the American Medical Assn. and one by the National Center for Health Statistics, a team led by health-care researcher David Mechanic of Rutgers University concluded that the time of a typical office visit actually increased by one to two minutes during the course of the decade.

The AMA survey found that the length of a typical office visit increased from 20.4 minutes in 1989 to 21.5 minutes in 1998, according to a report in the Jan. 18 New England Journal of Medicine. Using a slightly different approach, the second survey found the time increased from 16.3 minutes to 18.3 minutes during the same period.

The survey covered visits to a wide variety of physician offices, excluding anesthesiologists, pathologists and radiologists. It included new patients, old patients, those enrolled in HMOs and other types of health insurance plans. The average time was calculated by determining the number of hours each week devoted to seeing patients and dividing that by the number of patients.

One possible explanation for the finding is that the number of physicians per 100,000 patients increased by 21% during the period, but the number of office visits rose by only 17.7%.

Eating Fish May Lower Women's Stroke Risk

Women can significantly reduce their risk of having a stroke by eating more fish, according to new findings of a large national survey on women's health.

The study found that women who ate fish one to three times per month had a 7% lower risk of stroke than those who ate it less than once per month, according to a report in the Jan. 18 New England Journal of Medicine. Eating fish once a week was associated with a 22% risk reduction; two to four times a week, a 27% reduction, and five or more times per week, a 52% reduction.

The findings come from the Nurses' Health Study, a 14-year survey of 79,839 women. For the study, researchers only included data on strokes produced by blood clots in the brain, which account for about 83% of all strokes. The remainder are caused by bleeding into the brain, which is not affected by eating fish.

Dr. Kathryn M. Rexrode of Brigham and Women's Hospital in Boston and her colleagues compared the diets of women in the study who had strokes to those of women who did not. The findings took into account differences in age, smoking and other cardiovascular risk factors.

The reduction in risk is thought to result from omega-3 fatty acids, which are common in fish and help keep blood from clotting. In a separate part of the study, the team found that women with the highest intake of omega-3 fatty acid from dietary supplements--as contrasted with fish consumption--had a 33% reduced risk of stroke.

Supplement Tests Well Against PMS

A dry extract of the agnus castus fruit (Vitex agnus castus) may provide the first effective treatment for premenstrual syndrome, according to German researchers. A team at the Institute for Health Care and Science in Huttenberg studied 170 women with severe PMS. Eighty-six of them were given daily doses of the supplement, called Ze 440, for three months and 84 received a placebo. The women were graded during each subsequent period for six symptoms: irritability, mood alteration, anger, headache, breast fullness and bloating.

The team reported in the Jan. 20 British Medical Journal that patients who received the supplement had a significant improvement in all symptoms except bloating. Overall, more than half the women had a 50% or greater overall improvement in their symptoms, and side effects were few and mild. The study was sponsored by Zeller of Switzerland, which manufactures the supplement.

VA Hospital Mortality Seems Lower for Blacks

African Americans typically have a higher death rate than whites when they are hospitalized, a fact that is usually attributed to poorer access to health care and subtle bias. A new study, however, finds that blacks admitted to Veterans Affairs hospitals have a 25% lower risk of dying than do whites, a surprising finding that cannot yet be explained, according to the authors.

A team led by Dr. Ashish Jha of the San Francisco VA Medical Center and UC San Francisco studied the records of nearly 40,000 patients admitted to 147 VA medical centers during 1996. The patients suffered from one of six common medical conditions, such as heart failure and pneumonia. The team compared death rates at one month and six months after admission.

The team reported in the Jan. 17 Journal of the American Medical Assn. that the overall mortality at 30 days was 4.5% in black patients and 5.8% in whites. Mortality among blacks was lower in each of the six disease categories.

Report Counts Births Aided by ART

More than 28,000 babies were born using assisted reproductive technology (ART) in 1998, the most recent year for which figures are available, according to a new report issued Jan. 18 by the American Society for Reproductive Medicine. According to the report, 360 clinics nationwide performed 80,634 ART cycles in which human eggs were fertilized with sperm in a laboratory and transferred into a woman's uterus. These procedures resulted in the birth of 28,500 babies. About 25% of the ART cycles resulted in a live birth, a slight improvement from the previous year.

The full report is available at the Web site of the Centers for Disease Control and Prevention: http://www.cdc.gov/nccdphp/drh/art98.

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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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