Adapted from the Short White Coat blog on Boston.com
If you’re a medical intern, most of what you need to do your job can be pulled off a computer screen: Blood test results. Paged messages. Orders to start a medication. All but, of course, how sick a patient is.
Researchers at Johns Hopkins University and the University of Maryland, suspecting that more and more of an intern’s time is spent in front of a computer, looked into just how today’s intern spends her working hours on an inpatient ward. They asked trained college students to shadow 29 internal medicine interns from two different Baltimore teaching hospitals and document how much time they spent talking to patients, eating lunch, reading charts, and the like — over the course of three weeks. Their recently published results confirm a trend that old-timers nostalgically lament and that those of us in training know to be all too true: Only a small percentage of our time is spent in direct patient care.
The interns in the study spent just 12 percent of their time with patients — on average, about eight minutes with each patient each day. Nearly as much time (7 percent) was spent walking. In contrast, they spent 64 percent of their time in indirect patient care — for example, talking to other doctors and nurses (20 percent of total time) or writing patient notes. They spent a full 40 percent of their time in front of a computer screen — writing notes, placing orders, and reading electronic records. Fifteen percent went to educational activities. The authors compared these findings with those of similar studies conducted before the ACGME, the regulatory board for residency programs, first limited how many hours interns could work at a time and over a given week in 2003. In the first of these time motion studies, in 1989, interns spent about 20 percent of their time with patients and split the rest between documenting (42-45 percent) and sleeping and eating (up to 40 percent). Subsequent pre-2003 studies had similar results.
How do we explain the small but noticeable shift toward less time with patients? Today’s interns have more information to wade through in each patient’s chart. In the move toward team-based care, they spend increasing amounts of time talking to various members of the health care team: TBW (touch base with) you fill-in-the-blank (consulting doctor, physical therapist, case manager) is an inevitable item times 10 on their to-do lists.
I don’t quite agree with the Baltimore researchers’ assumption that less direct time with patients is necessarily a strike against our ever-elusive aim of patient-centered care. After all, as I try to remind our patients (though I know firsthand how difficult it is to believe), we spend the vast majority of our time thinking about and working for them even when we aren’t in their line of sight.