A few patients can monopolize most of your time, study finds

Some people can't see enough of their primary care physicians.

According to a recently published study, a small portion of patients (2%) took up a large portion (18%) of total primary care visits at the Mayo Clinic in Rochester, Minn. Many persistently high primary care users seem to be "overserviced but underserved," because their needs are not met through increased medical care, researchers said.

Some of these patients might benefit from disease-management interventions or psychosocial support, said the study's authors in the July/August Annals of Family Medicine.

"If there's another way to [treat] these patients, it will potentially free up physicians," said James Naessens, MPH, lead study author and clinical associate in the Mayo Clinic Division of Health Care Policy and Research.

Researchers examined office visits by 54,074 patients to the clinic from 1997 to 1999. High primary care use was defined as 10 or more visits in a year, and persistently high use meant having 10 or more annual visits for two consecutive years.

Among adults, researchers identified four diagnosis groups as predictors of repeated high primary care visits: unstable chronic medical conditions, conditions requiring reassurance, minor time-limited psychosocial conditions, and minor signs and symptoms. The study said the visits take access and time away from other patients with more straightforward medical problems.

"It's actually something that all family physicians deal with," said Mary Jo Welker, MD, a member of the board of directors of the American Academy of Family Physicians. "If you only have a few [of these patients], then they don't clog up the practice. But if you have quite a few of them, it will."

Dr. Welker remembers one patient who came in three days a week. "If we didn't see her, she would go to the emergency room. She was afraid that she was going to die of something and that we were all going to miss it," said Dr. Welker, chair of the Dept. of Family Medicine at Ohio State University.

Dr. Welker said physicians need to be patient when dealing with high-use patients who may have psychosocial issues.

Wilmington, Del., family physician Rebecca Jaffe, MD, said some patients might just need to hear words of comfort from their physician.

"Sometimes reassuring them makes more sense than pooh-poohing them. I don't think that's a bad use of time," Dr. Jaffe said.