DUTY, DOCUMENTATION AND PRESENCE
What is the physician experience of fighting against finite time in the clinical setting? How do competing demands for time—from documentation to bedside conversation—interplay with the fulfillment physicians receive from work?
It is no secret that the computer-facing aspects of medical practice are time consuming. A 2016 study published in the Annals of Internal Medicine found that physicians in ambulatory care settings may spend up to “two additional hours…on electronic health record (EHR) and desk work” for every hour spent face-to-face with patients (1). This “desk work”—from documentation of treatment plans to completion of legal forms necessary for billing and patient services—can place significant time and resource burden on providers (2). In fact, in a recent survey conducted by Medical Economics, “paperwork and administrative [tasks]” ranked first on the “list of issues ruining medicine for physicians” (3). Given how commonly physicians endorse time pressure at baseline as they seek to address patient concerns and engage in therapeutic conversation all while respecting clinic or unit schedules, any additional tasks—especially if not perceived as clinically useful—may increase "stress, burnout, and [even] intent to leave" medical practice (4).
Yet "desk work" is not all bad. Recording clinical thought processes, organizing treatment plans and ensuring adherence to various guidelines and safety checklists can “[make] us better physicians and…[force] us to think more clearly and methodically,” asserts one family medicine doctor (5). Physicians may even find the time spent writing notes valuable insofar as it facilitates research, continued medical education and thoughtful diagnostic reasoning—all beneficial to patient care. Moreover, in the age of increased specialization, multiple providers and interdisciplinary care, documentation can help to “centralize” information, enhance communication, pool intelligence, and even prevent medical error (2,6,7). Herein lies a potential conundrum for clinicians: with limited time, how does one balance the pros and cons of screen/desk time with face time, the historical rationale of medical practice?
A hospitalist is taking care of twenty patients on a medical floor. She calculates that spending just fifteen minutes with each patient/family at the bedside will take five hours of her nine hour day. She also has to participate in interdisciplinary rounds for all patients, write numerous notes, think about plans, conduct appropriate research where needed, and give medical students a lecture—all in the same day.
Sinsky C, Colligan L, Li L et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine. 2016;165(11):753-60.
Lee B. Doctors Wasting Over Two-Thirds Of Their Time Doing Paperwork. Forbes. September 7, 2016.
Medical Economics Staff. What's ruining medicine for physicians: Paperwork and administrative burdens. Medical Economics Journal. 2018;95(24).
Prasad K, Poplau S, Brown R et al. Time Pressure During Primary Care Office Visits: a Prospective Evaluation of Data from the Healthy Work Place Study. Journal of General Internal Medicine. 2020;35:465–472.
Sanders JH. How Much Paperwork Is Too Much? Fam Pract Manag. 2005;12(1):12.
Ammenwerth E and Spotl HP. The Time Needed for Clinical Documentation versus Direct Patient Care: a Work-sampling Analysis of Physicians’ Activities. Methods Inf Med. 2009;48(1):84-91.
Siegler JE, Patel NN, and Dine CJ. Prioritizing Paperwork Over Patient Care: Why Can't We Do Both? J Grad Med Educ. 2015;7(1):16–18.