A recent study conducted by researchers at Johns Hopkins University and the University of Maryland looked at what activities medical residents perform during a typical shift at the hospital, and how much time is dedicated to each. During a period of 900 hours, the researchers recorded how much time was spent speaking to and examining patients, meeting with families, attending educational conferences, discussing treatment plans with other doctors, sleeping, eating, and walking around the hospital. Results showed that the interns spend nearly half of their time in in front of computers updating electronic medical records and just eight minutes with each patient in a typical day, or 12 percent of their time. But why are doctors spending such little time with patients?
Other than the amount of time required to manage and update electronic records, the decrease in time residents spend with patients is due to recently instated constraints on the hours residents work. They can only work an average of 80 hours per week, averaged over a four week period, with caps on the duration of each shift. Each four week period must also include one mandatory day off per week. While these regulations were put in place to improve efficiency and prevent interns from being burned out, helping to protect the safety of patients, an unintended consequence is that interns don’t have the time to spend with each patient that they used to.
To save time, doctors rely only on medical records to learn about a patient’s symptoms, health history, and family history. They then cut their patient interactions short and skip on the niceties, including introducing themselves or even sitting down while speaking with patients and their families. As a result, they miss out on connecting with their patients and learning things that that they could only learn through more extended questioning and observation of more subtle signs, which can sometimes make the difference in treating a patient.
Not surprisingly, this less personal approach to treatment has led to a decrease in patient satisfaction. But more alarmingly, it’s also had a negative effect on patient outcomes and has contributed to an increase in inappropriate prescribing. Experts fear that residents who are trained according to these methods will take these habits with them as they start their own practices, which they believe will perpetuate a decreased quality of care.
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Sources: nytimes.com and acgme.org