Ney John, Wilson Andrew Michael, Raphaelson Marc, de Havenon Adam
Yale University School of Medicine (JN), New Haven, CT; UCLA David Geffen School of Medicine (AMW), Los Angeles, CA; Martinsburg VA (MR), Martinsburg, WV; and Yale University School of Medicine (AH), New Haven, CT.
Neurol Clin Pract. 2025 Feb;15(1):e200404. doi: 10.1212/CPJ.0000000000200404. Epub 2024 Dec 4.
The neurologic examination is a key part of neurologist visits. The neurologic examination leads to more accurate diagnoses, avoidance of unnecessary tests and procedures, and a stronger doctor-patient relationship. However, the neurologic examination takes time to perform, leading to longer visits with neurologists than with other specialists. We hypothesize that the neurologic examination adds quantifiable time to patient visits to a neurologist.
We examined a 5-year cross-section of the National Ambulatory Medical Care Survey, 2012-2016, selecting visits to a neurologist. We extracted an indicator for neurologic examination, time spent with the patient in minutes, patient demographics, new or established visit, reasons for visit, new vs chronic problems, insurance status, geographic region, collection year, and survey design variables. We report descriptive statistics among patient visits with and without neurologic examinations and built a generalized linear model of visit time and neurologic examination with patient and visit information as covariates and interaction terms between neurologic examination and new/established visits. A subgroup analysis was conducted by reasons for visit. All analyses incorporated survey design variables for accurate standard errors.
There were 4,009 patient visits among 211 neurologists, comprising 11.3 million annual visits in the weighted sample. Neurologic examination was reported in 58%, with no difference in demographics, geographic regions, or reasons for visit between those who did or did not receive a neurologic examination. The mean time spent with the patient in visits with a neurologic examination was 29.9 minutes, compared with 25.0 minutes without ( = 0.002). In the adjusted model, new visits with a neurologic examination were associated with 4.1 minutes greater time spent with the patient (95% CI + 0.6 minutes, +7.7 minutes, = 0.02) and established visits with a neurologic examination were 4.6 minutes longer (95% CI + 1.5 minutes, +7.5 minutes, = 0.006.) In subgroup analysis, association of neurologic examination with time spent with the patient was greatest for visits for pain (+6.7 minutes, 95% CI + 0.7 minutes, +12.9 minutes, = 0.03) and known neurologic diagnoses (+7.5 minutes, 95% CI + 4.2 minutes, +10.7 minutes, < 0.001).
This study demonstrates the association of neurologic examinations with increased time spent with the patient in ambulatory care. Further work is needed to assess the effects on medical decision making, costs of care, and patient access to neurologists.
神经系统检查是神经科医生诊疗的关键部分。神经系统检查有助于更准确的诊断，避免不必要的检查和程序，并加强医患关系。然而，神经系统检查需要花费时间来进行，这导致患者看神经科医生的时间比看其他专科医生的时间更长。我们假设神经系统检查会增加患者看神经科医生的可量化时间。
我们研究了2012 - 2016年国家门诊医疗护理调查的5年横断面数据，选取了看神经科医生的就诊病例。我们提取了神经系统检查指标、与患者相处的时间（以分钟计）、患者人口统计学信息、新就诊或复诊、就诊原因、新问题与慢性问题、保险状况、地理区域、收集年份以及调查设计变量。我们报告了有和没有进行神经系统检查的患者就诊情况的描述性统计数据，并构建了一个广义线性模型，将就诊时间和神经系统检查作为因变量，患者和就诊信息作为协变量，以及神经系统检查与新就诊/复诊之间的交互项。根据就诊原因进行了亚组分析。所有分析都纳入了调查设计变量以获得准确的标准误差。
211名神经科医生中有4009例患者就诊，加权样本中每年有1130万次就诊。58%的就诊报告进行了神经系统检查，接受或未接受神经系统检查的患者在人口统计学、地理区域或就诊原因方面没有差异。进行神经系统检查的就诊中，与患者相处的平均时间为29.9分钟，未进行检查的为25.0分钟（P = 0.002）。在调整模型中，进行神经系统检查的新就诊与多花4.1分钟与患者相处时间相关（95%置信区间为 + 0.6分钟， + 7.7分钟，P = 0.02），进行神经系统检查的复诊则多花4.6分钟（95%置信区间为 + 1.5分钟， + 7.5分钟，P = 0.006）。在亚组分析中，对于因疼痛就诊（多6.7分钟，95%置信区间为 + 0.7分钟， + 12.9分钟，P = 0.03）和已知神经系统诊断就诊（多7.5分钟，95%置信区间为 + 4.2分钟， + 10.7分钟，P < 0.001），神经系统检查与和患者相处时间的关联最大。
本研究表明在门诊护理中，神经系统检查与增加和患者相处的时间相关。需要进一步开展工作来评估其对医疗决策、护理成本以及患者看神经科医生机会的影响。
