Blog | Tuesday, August 11, 2015

On life support: the amount of clinical time doctors spend with patients


How much time do doctors actually spend with patients during a typical day?

The answer to this question should trouble any good and competent physician. It's been shrinking year by year, and has now reached a critically low level. In fact, if it were a laboratory result or an imaging reading, it would probably be flagged as one requiring immediate attention!

For most of the frontline specialties, whether we are talking about hospital medicine, primary care, or emergency medicine—the ones where patient interaction actually matters the most—the problem is the most acute. So what happened and exactly what is taking so much time away from doctors? It's a combination of increased documentation and bureaucratic requirements, combined with a massive amount of time that is now spent on computers—performing data entry “type and click tasks”.

A study in the Journal of General Internal Medicine not so long ago showed that medical interns now spend only 12% of their whole day in direct patient care. That's a shocking statistic. It's a problem that's evident at the frontlines of medicine in any hospital—seek out a doctor (or even a nurse for that matter, but that's a whole different discussion) and they will invariably be found staring at a computer screen. Even when with a patient, the imperative is to get the information needed as soon as possible so that they can go back to the computer to start entering in information. And contrary to what some may advocate, the solution is certainly not to take computers into the patient room, just to have the doctor staring away from the patient for most of their interaction.

If any frontline physician is honest with himself or herself, the time they spend with patients is likely to be well under 20%, or perhaps even 10% of their total day. I once worked with a colleague who felt so overwhelmed with data entry tasks, that it was probably less than 5%, with greater than 80% of her day on the computer. It's a sad way for someone who was once committed to going to medical school for all the right reasons, to spend their days practicing medicine.

So how about a suggestion? Start a movement called the “50% patient time movement,” that seeks to do everything possible to take doctors towards a higher percent of their time with patients and less with IT and documentation. The task force could work on improving health care information technology, streamlining bureaucracy, and better communication skills. As well as making our patients happier and allowing doctors to be doctors, this also has the double advantage of enabling doctors to be far more productive and see more patients. Although 50% is probably an unrealistic number to ever get to, it does at least set the bar high. Our patients are yearning out for this, and if nothing else—we should do it for them.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.