Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients.
What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their desktops than with their patients.
Two recent studies give us quantitative estimates of the stupendous amount of time physicians spend on computers, rather than in direct contact with their patients. In one study, researchers directly observed physicians in outpatient clinics, asking these doctors to document the time they spend on the EHR after hours. The study assessed physicians from four specialties: family medicine, internal medicine, cardiology, and orthopedics. The study found, on average, that doctors spend half their working time on the EHR.
In the second study, researchers gathered data on how much time 500 primary care physicians spent logged into their EHRs, but not interacting with patients. Using this different methodology, they found disturbingly similar results — with physicians spending less than half of their work hours in direct patient care. Here is a picture of that result.
These studies confirm what many of my physician friends and colleagues tell me about their work lives: that their work day never ends. Their kids go to bed, and they go back to their computers, to document all their clinical activities thoroughly on the EHR, so they don’t get dinged for offering poor quality of care.
It is ridiculous to put physicians through ten to twenty years of schooling only to require them to spend half their work time as medical clerks. Health systems and healthcare practices need to invest in administrative resources that free doctors to do doctoring. One of my orthopedic colleagues told me that in his practice, he audio-records key moments of the clinical encounter—using a watch/cell phone connection—and then trained clerks listen to these moments and enter in billing information on the EHR, and log other activities that were performed during the clinic visit. This method allows him to concentrate on seeing patients, while letting someone else concentrate on documenting his clinical activities.