This blog post in the NY Times is a few months old but it is still relevant. It talks about relationships between the doctor and patients and the importance of those interactions in the healing process and…..how those days are gone. The blog describes a new study that “doctors-in-training are spending less time with patients than ever before.” Pauline Chen MD, author of the blog, details how the history of how residents got their hours cut from the 1980s until now and how they may have got it wrong:
- The Journal of General Internal Medicine reveals that while the initiatives of the last two decades were implemented with the best of intentions, the result has been a perfect storm of unintended consequences.
- As in earlier studies, the researchers found that current interns spend the majority of their time in activities only indirectly related to patient care, like reading patient charts, writing notes, entering orders, speaking with other team members and transporting patients.But when they calculated the amount of time spent face to face with patients, the researchers found that interns were devoting about eight minutes each day to each patient, only about 12 percent of their time.
- “Medicine is such an experiential learning experience. It’s really astonishing that so little time is spent at the patient’s bedside.”
- 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.As a result, efficiency has become an overriding concern. Compared with previous generations of young doctors who spent a significant percentage of time eating or trying to sleep, the interns in the current study spent only about 10 percent of their time doing so.
- Young doctors required to see the same number of patients in less time try to speed up their work by culling from computer records all available information about patients, their symptoms and even their physical exam before seeing them in person. 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.
Sound familiar? Sure it does because the same experience is happening to almost all of us doctors in practice today. We are rushed, we spend less time with the patient and more with the computer, we always try to speed up our visit and we try to pre-fill our computer records even before we walk into a room. This training has created INDUSTRIALIZED MEDICINE to the detriment of what I call AUTHENTIC MEDICINE. What we have now is a travesty to our heroes and mentors who practiced medicine before us. Yes, this is not your father’s healthcare system but in many ways that is a really bad thing.