Blog | Thursday, February 18, 2016

Direct patient care time is a moral problem as much as a practical one

I was dining at a friend's house recently after a long day in the hospital. He has just bought a beautiful new home with his rapidly expanding family, and like anyone who has just moved into a new house, his spare time is invariably spent working on getting everything in order and undertaking small upgrades to make the new place as perfect as possible. He's quite DIY-oriented (unlike myself) and was spending a lot of time doing minor construction work. When I asked him why he didn't just hire someone else to do the work, he told me that he'd rather just do it himself and that it was far better and more enjoyable than “just going into the hospital to play around with computers all day.”

I found this a profound statement, and sad on a number of different levels. His hospital had a new computer system installed a few months ago, and like a lot physicians—especially those in generalist specialties—he was now finding himself spending the vast majority of his day staring at a screen, typing and clicking away. He is a physician who really enjoys clinical medicine, values his time with patients, and didn't go to medical school to do a desk job (like all doctors).

Not so long ago, I wrote a piece about the amount of clinical time that physicians are spending with patients being on life support, primarily because of healthcare information technology. Some studies suggest that medical interns are now spending only around 10% of their day in direct patient care, with the bulk of the rest sitting at a computer terminal. I can well believe that.

In fact, if my own experience is anything to go by, I wouldn't be surprised if during a 12-hour day, patients are lucky if their doctor spends 1-1.5 hours total with them. Think long and hard about that statistic, because it's a disaster for the practice of medicine and for our patients. A typical scenario goes something like this: 5 minutes with you and then 20-25 minutes navigating an inefficient and cumbersome system to document what's just happened! Interacting with a computer during the actual encounter is even worse, and not appreciated by patients when they see their doctor turning around and looking at a screen every few seconds instead of talking to them.

The answer, however, isn't to take the technology away and go back to the ancient days of pen and paper, but rather to design better and more optimal solutions: with a simple acknowledgement that the best IT of the future will be that which is “seen and not heard”. Electronic medical records and physician order entry systems that are quick, super easy to use, and properly reconciled with frontline clinical workflow.

Physicians simply cannot spend 80%-90%-plus of their day sitting down at a computer terminal. It's not what being a doctor is all about. So much of medicine is about communication and yes, much of it is also still an art. The same dismay would result if you turned another profession that views itself as an art upside down and into a screen-staring job (whether it be a sportsperson, a film producer, or a teacher). Whatever we can do to tip the scale back towards patient care, must be done. Although it's unrealistic, and also nonsensical, to think that doctors could ever spend 100% of their day with their patients, there must be a palpable swing towards direct care time. This would not only be good for patients, but also increase productivity and efficiency—as doctors will also be able to see more patients in a meaningful way.

Going back to my friend, who now equates being a physician with going into hospital and “playing around with the computer all day”, the situation is not just an impractical one, but a big moral one too. Moral because it has so many consequences in terms of reducing job satisfaction for a noble, caring and hard-working profession. Moral because it makes every physician forget why they went into medicine in the first place. And most of all, moral because it robs our patients of the care they deserve when their physician is more pre-occupied with documenting the encounter than living it.

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.