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10 minutes!? Seriously?

July 13, 2009

I have officially completed one week as a family medicine resident. My preceptors are ever patient, the staff more helpful than I’m used to, and the patients mostly charming.

The arrangement of my schedule can create challenges at times; though I have the luxury of being allotted a half-hour per patient, I find it difficult to do a history, physical, counsel/teach, create a lab requisition, and write the prescription in this time. Especially when the computer hangs and crashes several times and a printout fails to appear. Electronic Health Records (EHR) can be one’s best friend or worst enemy. I think right now we are just distant aquantainces.

Back to fitting everything into the time allowed: Not all visits require all steps, but being a population older than the rest of the country, patients here bring more numerous and complex problems into the office. I do need to better learn how to manage the visit time and to get patients to talk about their main concern for the day. However, even when I explicitly ask them what they would like me to do for them in the visit, it can still be a tangle of ideas. I’m told these tricks will come with time, and I can’t wait to find them out!

I don’t want to have people waiting a long time in the waiting room if I can help it, but I also have to spend time with my preceptor reviewing the case and my ideas for management. And they have to sign my prescriptions, since we won’t be allowed to do that until January. The docs in the clinic are all keen teachers; some like to focus on evidence based medicine (EBM) and others help to fill in the context of the patient when we have our discussions. This helpful and necessary step does take time too, and I’m sometimes very worried about the number of patients and charts piling up (or rather, sitting down and collecting in a virtual queue, respectively). I’m lucky, as a resident – my priority gets to be learning – but full-on docs don’t get that benefit.

Dr. Gurley did the math and it is actually impossible to see all of our patients, do the adequate preventative care/screening, diagnostic workup, etc. [see KevinMD’s nice summary]. 36 minutes. That’s how much time each patient of a primary care physician (i.e. family doctor) gets each YEAR.

That is not enough. For the average patient, we get paid to give you a 10 minute visit (and you are able to have quite a number of those each year). Some doctors choose to take longer than 10 minutes. Some just take longer, even though they don’t try to. But we can’t take too long, because then none of our other patients will be able to get in to see you.  Too fast, too slow, we are unable to give everyone the care they need. Arthur Kleinman wrote about losing the ‘care’ in ‘health care’ for The Globe and Mail; fortunately, unlike the schools he describes in the article, my medical school did a lot to make sure we weren’t just robots that memorized facts. We are human beings whose job is taking care of people. And we have also started learning to take care of ourselves.

4 Comments leave one →
  1. July 14, 2009 10:50 am

    Quite interesting.

    How do you actually do your schedules of a day, I mean as a “full” doctor. Do you try and schedule someone every 10-15 minutes or do you deliberately leave gaps so that you have catchup or runover time?

    • July 30, 2009 6:59 am

      Everyone gets 10 minutes unless it’s something more complicated. Gaps are left in order to see patients who must be seen that day. Each doctor requests their own style of scheduling and the medical office assistants (MOAs) try to book according to those preferences.

      Most docs incorporate some gaps for ‘breaks’ or ‘catch-up time’ in case they are running late. But not all do this. 30-40% of gross earnings go to office overhead; with taxes, conference/textbook/medical journal subscriptions/insurance/hospital parking and other fees, it may be hard to come out even if this pace isn’t kept up. I’ve not had to balance a practice yet so I’m not sure how busy one actually must be in order to be earning what I’m told doctors are earning.

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  1. RT @DrOttematic: NEW blog post: 10 Minutes!? Seriously? drottematic.wordpress.com ~great view of physician time-management in patient exams! :) - Twitoaster
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