This is a problem I am currently experiencing. Right now, I'm on a clerkship trip in southern China, and we see about 50-60 patients with chronic heart diseases each day. Oftentimes, because there are simply too many people to see and not enough time to see them all, we end up rushing through the less severe cases. Obviously, then, the quality of care we offer to those people goes down. But at the same time, it is better to have seen everyone and have made sure to have given them a treatment plan than nothing at all, so time is of the essence, and we have no choice but to go through everything speedily.

Another common thing I've noticed here is patient anxiety. Frequently, there is absolutely nothing wrong with them, although they insist that they have heart problems, gastrointestinal problems, etc. But a physical exam reveals no inconsistencies. When you tell them that they are fine, they refuse to believe it...they almost DEMAND you tell them that something is seriously wrong with them, and expect to be given medication for it. But if there's nothing wrong with them, there's nothing we can do, and then the patient leaves unsatisfied. So to the patient, the quality of care they received was probably perceived as subpar, even though we did everything in our power to treat them.

In the ideal situation, if we were all smart about allocating resources and personnel, everyone would be able to receive good quality care. But that's very difficult to achieve, especially in a system as flawed as ours. It would be prudent, though, in redesigning/improving US healthcare, to always keep quality as a major priority.