Blog | Friday, April 26, 2013

QD: News Every Day--Medical interns spend 12% of their time on direct patient care

Medical interns spent 12% of their time examining and talking with patients, more than 40% of their time behind a computer and 7% of their time walking the wards, according to a new Johns Hopkins study that closely followed first-year residents at two large academic medical centers in Baltimore.

Observers followed 29 internal medicine interns at The Johns Hopkins Hospital and the University of Maryland Medical Center for three weeks in January 2012, for a total of 873 hours, using an iPod Touch to mark down what the interns were doing minute-by-minute.

The conclusions appeared online in the Journal of General Internal Medicine.

Interns spent 12% of their time talking with and examining patients; 64% on indirect patient care, such as placing orders, researching patient history and filling out electronic paperwork; 15% on educational activities, such as medical rounds; and 9% on miscellaneous activities.

"Most of us went into medicine because we love spending time with the patients. Our systems have squeezed this out of medical training," said Leonard S. Feldman, MD, FACP, the study's senior author and a hospitalist at The Johns Hopkins Hospital, in a press release.

The 12% figure "seems shockingly low at face value," Dr. Feldman said. "Interns spend almost four more times as long reviewing charts than directly engaging patients."

Studies in 1989 and 1993 found that interns spent between 18% and 22% of their time at the bedside. In those studies, however, researchers found that a large chunk of time was spent sleeping at the hospital.

Dr. Feldman questioned whether the time spent with patients is enough to give interns the experience they need. Better electronic medical records may help reduce time spent combing through patient histories on the computer. And, an intern's patients could be grouped together on the same hospital unit so the intern doesn't have to move from floor to floor to see patients.

"It's not an easy problem to solve," Dr. Feldman said. "All of us think that interns spend too much time behind the computer. Maybe that's time well spent because of all of the important information found there, but I think we can do better."