primary diagnoses, 600 unique medications, and approximately 150 unique laboratory tests (Semel et al., 2010). These findings highlight the variety of needs clinicians now address, along with the variety of interventions and diagnostic tests they must manage.

Further, physicians often feel as though they do not have enough time to meet their patients’ care needs (Burdi and Baker, 1999; Trude, 2003). Among primary care physicians responding to one survey, 30 percent reported not having adequate time to spend with their patients during a typical visit (Center for Studying Health System Change, 2004-2005), and a similar percentage of patients reported concerns about the amount of time their providers have to spend with them (AHRQ, 2010)—this despite evidence that the average length of a primary care visit has actually increased in recent years (Mechanic et al., 2001). Evidence suggests, however, that clinicians’ perceptions are warranted. One study found that meeting a standard patient panel’s acute, preventive, and chronic disease management needs would require more than 21 hours a day, as shown in Figure 2-4 (Yarnall et al., 2009).

As outlined above, the complexity of modern health care is reaching levels that challenge human cognitive capacity. Research in several areas has found that complexity can have negative effects on people’s ability to make decisions (Simon, 1979, 1990; Weick and Sutcliffe, 2001). Complexity can cause people to defer making a decision, choose the default option, make no decision at all, or make an incorrect decision (Dhar, 1997; Shafir and Tversky, 1992; Shafir et al., 1993). As one example, when confronted with highly complex situations, people tend to use mental shortcuts, or heuristics, to manage the volume of evidence (Berner and Graber, 2008; Bullen and Sacks, 2003; Kampmann and Sterman, 1998; Payne et al., 1993;


FIGURE 2-4 Time requirements for a primary care physician to treat a standard patient panel.

SOURCE: Data derived from Yarnall et al., 2009.

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