For every hour that some doctors devote to direct patient care they may spend about five hours on other tasks, often because they’re tied up with computer work, a Swiss study suggests. The results are based on observations of just 36 doctors-in-training at one hospital in Switzerland. But research dating back more than half a century has documented physicians dedicating a similar amount of their workdays to direct patient care, said Dr. Nathalie Wenger, lead author of the current study. “It has not really changed in 50 years,” Wenger, a researcher at the University Hospital of Lausanne, said by email. During the study period, the doctors spent an average of 1.7 hours per shift with patients, 5.2 hours using computers and 13 minutes doing both, Wenger and colleagues report in the Annals of Internal Medicine. Patient care might not necessarily be better if doctors had less screen time, but cutting back could still have some advantages, Wenger said. “It will clearly improve satisfaction of physicians, reduce their stress and improve medical education by freeing up time for that,” Wenger said. For the current study, Wenger and colleagues observed medical residents for a total of about 698 hours. Teams of observers recorded the residents’ activities throughout their shifts at the hospital, sorting tasks into one of 22 different categories such as direct or indirect patient care, communication, academic or nonmedical work. Day shifts typically lasted 11.6 hours, or 1.6 hours longer than scheduled, the study found. During day shifts, doctors spent about 52 percent of their time on activities indirectly related to patients such as writing in medical records, collaborating with other clinicians, looking for information needed to treat patients and handing off care to other providers. Physicians spent about 28 percent of their day shifts on direct patient care including clinical exams and medical procedures and rounds done as part of the residency program to review treatment with colleagues. They spent only about 2 percent of their time communicating with patients and families, and about 6 percent of their time either teaching, receiving training or doing academic research. During shifts, physicians spent up to about 45 percent of their time on computers, the study found. Beyond its small size and single site, other limitations of the study include the fact that residents knew they were being observed and may have adjusted their work accordingly, the authors note. It also wasn’t an experiment designed to prove how different uses of physician time influence patient outcomes. Still, the findings add to a growing body of research documenting how much of doctors’ time is taken up by administrative tasks, said Dr. Susan Thompson Hingle, a researcher at Southern Illinois University School of Medicine in Springfield who wasn’t involved in the study. “Having observed residents and talked with residents, I do not think the findings are unique to the Swiss,” Hingle said by email. “It seems as though the studies continue to confirm the enormous administrative tasks that physicians and physicians in training, regardless of level, clinical venue, or geographic location, are faced with.” Patients often complain that doctors don’t spend enough time with them and that physicians spend more time focused on the computer than on them, Hingle said. “When our attention is not on the patient, we miss important non-verbal cues; we are distracted and not actively listening; we miss opportunities to build a trusting, healing relationship with our patient,” Hingle added. “Without that trust, patient adherence is less which impacts patient outcomes, and patient satisfaction is less, which also impacts patient outcomes.” Source
