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Care for the Socially Disadvantaged and the 15-Minute Visit

Kevin Fiscella, MD, MPH; Ronald M. Epstein, MD

Arch Intern Med. 2008;168(17):1843-1852.

There is so much to do in primary care, and so little time to do it. During 15-minute visits, physicians are expected to form partnerships with patients and their families, address complex acute and chronic biomedical and psychosocial problems, provide preventive care, coordinate care with specialists, and ensure informed decision making that respects patients' needs and preferences. This is a challenging task during straightforward visits, and it is nearly impossible when caring for socially disadvantaged patients with complex biomedical and psychosocial problems and multiple barriers to care. Consider the following scenario.

Author Affiliations: Departments of Family Medicine (Drs Fiscella and Epstein), Community and Preventive Medicine (Dr Fiscella), and Psychiatry (Dr Epstein), and Division of Oncology, James P. Wilmot Cancer Center (Drs Fiscella and Epstein), University of Rochester School of Medicine & Dentistry, Rochester, New York.