8 Minutes of Patient Care

As residency draws to a close I find myself thanking a lot of the patients that I have cared for over the past four years. I have taken care of many of them during their happiest of times and their saddest of times and it amazes me the emotional connection that is formed in brief moments with perfect strangers in healthcare. Retrospectively, I feel like I filter out much of the other work that I did within the hospital walls and focused mainly on times spent with patients.

This suspicion was confirmed when reading the results published in the Journal of General Internal Medicine. Researchers followed interns around and categorized time spent sleeping, eating, talking with and examining patients, talking with families, attending conferences and meetings, and discussing treatment plans with other doctors. What they found is likely not surprising to any intern out there, but is really depressing to write down in black and white. The majority of the time was spent documenting in medical records, writing orders, or talking to other doctors about patient care; all very important, but all indirect forms of doctoring. They concluded that interns spend about 8 minutes per day with each patient they take care of. This is only about 12% of their total time in the hospital compared with 50% of the time in front of a computer screen.

There are likely a lot of things which are contributing to this. We are seeing more patients with fewer doctors in the United States; our time spent at the hospital is limited by duty hours; there are increasing demands on documentation for medico legal purposes. Unfortunately, there doesn’t seem to be much of the horizon to fix these issues.

So what are we to do? Here are some things that may be helpful and things that work for me:

1. Go directly to the source. Rather than spending time pouring over old electronic medical records and transfer records prior to seeing the patient, see the patient first. They will likely be able to give you a quick and relevant HPI and may lead you down a relevant line of questions that computer screen cannot.

2. Sit down. Whenever you go in to see a patient, find a chair (or, if the patient allows, the corner of the bed). Sitting will make you less rushed and will also give the appearance of being less rushed. Many studies show that patients feel significantly longer periods of time were spent with them when the physician sits down rather than stands.

3. Ask an unscripted question. At some point in your patient interview, ask a single question that helps you learn something unique about that person. We are so focused on efficiency (as is required of us in order to fit all our tasks into the day) that we lose sight of the fact we are talking to a person. We are all busy, but we all have 30 seconds for a fun fact about the people we care for.

 

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