Friday, May 31, 2013

8 Minutes Per Patient

The New York Times medical writer Dr. Pauline Chen discusses how doctors in training are now spending on average only 8 minutes per patient each day.

Some excerpts from her piece, "For New Doctors, 8 Minutes Per Patient":
[R]esearchers found that interns were devoting about eight minutes each day to each patient, only about 12 percent of their time...

The dramatic decrease in time spent with patients compared with previous generations appears to be linked to new constraints young doctors now face, most notably duty hour limits and electronic medical record-keeping. The study found, for example, that interns now spend almost half their days in front of a computer screen, more than they do with patients, since most documentation must be done electronically...

When finally in a room with patients, they try to speed up their work again, but by limiting or eliminating altogether gestures like sitting down to talk, posing open-ended questions, encouraging family discussions or even fully introducing themselves.

“We have to ask ourselves if spending more time on electronic medical records than with patients is time well spent,” said Dr. Leonard S. Feldman, senior author of the study and assistant professor of medicine and pediatrics at the Johns Hopkins School of Medicine. “If you’re only spending eight minutes talking to and examining a patient, something is certainly going to be missing.”
The article also notes that this will set a pattern for how these young doctors practice in the future:
A young doctor’s experiences during training strongly influence how he or she treats patients once in practice. In addition, because observation of diseases and their myriad manifestations is critical to building a doctor’s clinical skills, some worry that today’s young doctors won’t have had enough interactions with patients to be able to recognize the more subtle signs and symptoms of disease or of impending emergencies when they begin practicing on their own.
The newest generation of doctors may thus be more reliant on standardized protocols, and less adept at independent clinical judgment.

The combination of government-mandated work hour limits and mandated electronic medical records could change American medicine for decades to come -- and not necessarily for the better.

(Read the full text of "For New Doctors, 8 Minutes Per Patient".)