It takes just as much time to be a doctor today than it did 30 years ago, but much less of it is actually comprised of patient care.
If I broke down how much of my full-time week is actually devoted to caring for patients – actually speaking, touching and listening to patients – it’s probably around 1/3 of the time I spend at my job. Things are less efficient during residency, so perhaps I’ll do fewer dissonant, fuzzy, non-patient-care activities when in private practice. But for now, 33% is probably my average.
I’m spending most of my time in out outpatient clinic currently. I figure that for every minute I spend with a patient, I’ve just generated 2 minutes of required charting time. Do NOT presume that electronic medical records have added ANY efficiency to the world of documentation. They have done virtually nothing for what are already mind-boggling inefficiencies in medicine.
On top of charting, we spend time learning about “coding”. At my residency, we’re required to spend every Monday learning about this denizen of Isla de la Accountantista. This is the time when we dutifully file into a room and receive lectures from coders – people who generate entire yearly salaries (with full benefits) for their ability to move money from one organization to the next. They work in the health care field, yet could easily never interact with a patient – the one actually generating this money in the first place – in any form. The movement of money in medicine is so cumbersome (in America), full-time salaries are devoted just to making sure the right amount goes from point A to point B.
I also spend strange amounts of time talking about my patients, rather than talking to them. As one of many examples, Medicaid requires me to “precept” my patients. Nobody else on the planet requires this. In fact, it’s hard not to presume that they love this little policy quirk of their system – likely dreamed up by some highly-ethical but practically-dysfunctional government worker with their requisite Master’s degree and an insatiable need to control people – because if we forget to precept our patients, they won’t pay. So, I make sure to yammer to a senior doc about Gran Betty’s toe fungus so we can get paid. I also spend untold amounts of time talking to insurance companies, or pharmacies, about how it really would be good to cover, oh, Jerry’s Plavix since he just had quad bypass surgery.
Aside from the fact that I didn’t become a doctor because of an innate attraction to documentation (wait! somewhere I should write down the fact that I’m blogging right now), the reality is that every minute spent with a patient is, from a certain point of view, wasted time. Pretty soon, I propose, doctors should not see people at all. They should just sit in a chair and what it might have been like to actually interview a patient. They could even wear their white coats, all lined up at a computer bank and typing frantically:
Woke up today. Documented that I woke up today. Ate breakfast. Documented both that I ate breakfast AND that I got dressed (see forgotten documentation supplement A). Drove to work, documenting the drive during drive itself, which led to lights and sirens (ignored while engrossed in avoiding oncoming traffic and documenting said traffic). Currently very difficult to document with handcuffs and a cracked frontal bone d/t wreck. Documented wreck. Went to hospital, travel distance and times documented in Appendix B. Arrived in ER, but no doctors available.
Busy documenting my visit.
Head wound probably not serious anyway.