The Annals of Family Medicine is becoming one of my favorite journals. I been very impressed with the quality of the papers published their and as soon as they get RSS feeds (I lobbied Kurt las month about this) we will be all set.
The article about time that physicians spend with their patients is interesting to me because it seems that most physicians spend rather little time with their patients even though the paper suggests that the results revealed that physicians actually spend more time with patients than was previously thought.I'm certain that I spend much more than 50% of my day in the exam room .. and my day is certainly longer than 8.6 hours
Another very interesting article in this issue looks at the time that physicians spend outside of the examining room.
The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records
It would be interesting to see how things looked for practice with electronic medical records. I think that Paul Chang did some work on this subject in the late 1980s. Until we get to the sort of usability improvements that we really need, I expect the electronic medical records will improve efficiency only marginally.
Finally, our old friend Brian Alper (who has finally been able to get his life work, Dynamed - into the mainstream) has a very good paper that reviews the clinical utility of such a resource. I understand that Brian has improved the usability of Dynamed quite a bit recently. the information indicted that is quite good and Brian keeps it up to date almost single-handedly. He's been doing this since he was a third year medical student and his resource is certainly competitive with other products that cost much more. Ideally, a resource such as Dynamed would become integrated within the electronic health record.
But that's "web 2.0" whining all over again. a promise. No more today.
I'm working on a post about physicians beyond work! (Yes, there is life beyond the practice!) Please visit my site next week. If you want a hint, visit it now and read about nurses!
Posted by: Christina | December 10, 2005 at 12:18 AM
Doctor i liked this article from you very much...I am a medical student from India.I greatly agree with your ideas because now a days doctors do not find it very essential to have a good rapport with their patients.
Posted by: jobin martin | December 12, 2005 at 02:19 PM
Hi, Doc.
It does seem to make sense that an EMR system would save doctors a lot of extra time, which they could then spend with patients.
I can't help but remember, though, the myth of the paperless office, in which the power and efficiency was supposed to free us all to do other things.
All that power, as it turned out, simply raised the bar, requiring us to do even more work just to keep up with everybody else.
Could it be possible that when a killer EMR system finally finds its way to every doctor's office, every doctor will end up having to do twice as much during the exam?
For the record, I'm not a health professional.
Cheers!
Posted by: Miguel | December 12, 2005 at 07:36 PM
Hi Doc. Me again. Thanks for posting my comment. It was arguably the first time I had ever commented on a blog... sort of, like, getting my toes wet before taking the plunge and starting a blog of my own.
Thing is, you haven't written anything since that day, which is remarkable considering that your archives stretch all the way back to 1999!.., Unless... Oh my God, did my comment kill you???
Har har
Nuke this comment. I'm just being facetious.
Posted by: Miguel | January 10, 2006 at 05:05 PM