Residents need to spend more time with patients..

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http://www.medicaldaily.com/article...-spend-more-time-walking-hospital-patient.htm


I don't even know where to start with this!

 

[deleted109597]

http://www.medicaldaily.com/article...-spend-more-time-walking-hospital-patient.htm
I don't even know where to start with this!

Just break it down piece by piece. The title is a flat out lie.

64% Indirect patient care, placing orders, researching patient history, filling out electronic paperwork

I'm not shocked at all by this, actually. We are the highest paid data entry clerks in the world.

With the new Obamacare healthcare initiative, doctors will have to spend less time combing through medical records, as all records will be electronic and easily searchable. Hopefully this will bring about a change that seems is needed in patient care.

I've found EMRs to do the opposite. Yes, they allow you to easily look, but at the same time, they allow people to spend hours looking over the chart and arguing with you because the patient got stressed 48 months ago or some other inanity.

 

[dchristismi]

Poorly written, but not surprising. The random radiology paragraph came from where?

EMRs are a nightmare. They make it easy to bill and extract "meaningful" data (har), yet create a document that makes no sense and is impossible to interpret. That, and none of these wonderful systems can talk to each other.

And 7% of IM interns spend their time walking. They aren't called "walking rounds" for nothing. I spent a surprising amount of time walking in my ED. Last time I wore a pedometer, it was easily 10K steps for am 8h shift. Yes, I do a lot of walking. But a spread out department doesn't help.

 

[Arcan57]

Poorly written, but not surprising. The random radiology paragraph came from where?

EMRs are a nightmare. They make it easy to bill and extract "meaningful" data (har), yet create a document that makes no sense and is impossible to interpret. That, and none of these wonderful systems can talk to each other.

And 7% of IM interns spend their time walking. They aren't called "walking rounds" for nothing. I spent a surprising amount of time walking in my ED. Last time I wore a pedometer, it was easily 10K steps for am 8h shift. Yes, I do a lot of walking. But a spread out department doesn't help.

The meaningful data problem is so true, especially if you're signing off on someone else's work. With a paper t-sheet or even the old scribble the H&P and PE onto the chart style, you could quickly assess from chief complaint what should and shouldn't appear on the chart. Since we've switched to electronic T-sheets, I can't review the actual t-sheet without erasing the midlevel from case and have to look at the printed-out form. Which with all those easily extractable pertinent positives and negatives is essentially unreadable.

 

[pickupthepace]

Something else that really grinds my gears - when asking the pt "So, what other medical problems do you have?" And they say - "just look it up in the computer, it's all in there."

arg

 

[glorfindel]

Something else that really grinds my gears - when asking the pt "So, what other medical problems do you have?" And they say - "just look it up in the computer, it's all in there."

arg

It is a comforting myth that "spending time with patients" is the most valuable things doctors-in-training can do. Often, the time spent with patients is horribly unproductive, inefficient, etc.

 

[TooMuchResearch]

http://www.medicaldaily.com/article...-spend-more-time-walking-hospital-patient.htm


I don't even know where to start with this!

I wouldn't worry about it. That "medical" site has stories about cupping (alternative "medicine"), goldfish (the fish, not the delicious cracker), and the Japanese Finance Minister on its home page.

 

[GeneralVeers]

It is a comforting myth that "spending time with patients" is the most valuable things doctors-in-training can do. Often, the time spent with patients is horribly unproductive, inefficient, etc.

The least productive part of my day is "spending time" with patients. It detracts from actual patient care, slows down diagnostics, and the crazy patients who ramble make me angry.

90% of the time talking to the patient/physical exam doesn't change my workup. I order most tests based on age, chief complaint, medical history, and vital signs.

 

[survivordo]

My typical day as a surgery intern is something like this. Signout at 6:00-630, see patients and write notes from 630 to 730 or 800 depending on how many patients I actually see (usually 10-15) and then I bust my ass all day seeing consults and otherwise taking care of business until it's all done. I would definitely agree that the minority of my time is spent actually interacting with patients, the one exception to this would be when changing wound vacs/dressings but really most of my day is spent cruising around the hospital taking care of business. No complaints, just stating the facts.

Survivor DO

 

[survivordo]

Also, did anyone see this article on transfer of bacteria via beer pong balls on the same site? And here I was always worried about catching the Herp from whoever else was drinking off the same cup!

Survivor DO

 

[QuackaDO]

Anyone notice that this article/study AND the one saying that the reduction in work hours has not caused a decrease in medical errors are BOTH from Johns Hopkins Department of Internal Medicine? Agenda maybe? Just sayin...

 

[goodoldalky]

The least productive part of my day is "spending time" with patients.

Haha, I hear that.

Doc: "What brings you in Ms. Jones?"
Ms. Jones: "Well it all started two weeks ago last Tuesday when I ate a sandwich...."

 

[RustedFox]

Haha, I hear that.

Doc: "What brings you in Ms. Jones?"
Ms. Jones: "Well it all started two weeks ago last Tuesday when I ate a sandwich...."

I particularly love it when they hand me a page or two of hand-scrawled notes that make limited sense at best:

10:45 AM - ate banana and two grapes, symptoms did not return.

 

[Perrotfish]

I particularly love it when they hand me a page or two of hand-scrawled notes that make limited sense at best:

10:45 AM - ate banana and two grapes, symptoms did not return.

At the other extreme, I remember once when I was in surgery clinic as a medical student the patient handed me a typed H&P with an assessment and plan. Apparently he was a retired surgeon. He told me just to go read it to my attending and come back when the tests were ordered.

 

[alphaholic06]

at the other extreme, i remember once when i was in surgery clinic as a medical student the patient handed me a typed h&p with an assessment and plan. Apparently he was a retired surgeon. He told me just to go read it to my attending and come back when the tests were ordered.

lol!!!!

 

[gutonc]

I particularly love it when they hand me a page or two of hand-scrawled notes that make limited sense at best:

10:45 AM - ate banana and two grapes, symptoms did not return.

I have a patient who arrived for her first appointment with me with 4 pages of typed PMH and 7 pages of PSH. She is as crazy as you would expect given those findings.

 

[deleted6669]

I have a patient who arrived for her first appointment with me with 4 pages of typed PMH and 7 pages of PSH. She is as crazy as you would expect given those findings.

and most of the 4 pages was the allergy list(all cause anaphylaxis)...."water, steroids, epinephrine, sunlight, rhythm and blues music, cocker spaniels, green grapes, tylenol(but not vicodin or percocet, etc)

 

[alphaholic06]

and most of the 4 pages was the allergy list(all cause anaphylaxis)...."water, steroids, epinephrine, sunlight, rhythm and blues music, cocker spaniels, green grapes, tylenol(but not vicodin or percocet, etc)

I actually had a patient once that said she had an anaphylatic reaction to sunlight. She convinced someone to prescribe her an epi-pen.

 

[gutonc]

and most of the 4 pages was the allergy list(all cause anaphylaxis)...."water, steroids, epinephrine, sunlight, rhythm and blues music, cocker spaniels, green grapes, tylenol(but not vicodin or percocet, etc)

That was actually a different 2 page document.

 

[Arcan57]

I actually had a patient once that said she had an anaphylatic reaction to sunlight. She convinced someone to prescribe her an epi-pen.

There are people that have sunlight induced urticaria. I remember a pro fisherwoman that was being treated for it when I did my derm rotation. I kinda filed it away with my thrombophilic long-haul truck driver as "wrong job for the disease".

 

[dchristismi]

Yeah, but I'm guessing that lady didn't have porphyria...

 

[Textbookversion]

At the other extreme, I remember once when I was in surgery clinic as a medical student the patient handed me a typed H&P with an assessment and plan. Apparently he was a retired surgeon. He told me just to go read it to my attending and come back when the tests were ordered.

That's awesome. I want to be that old dude some day.

 

[geauxg8rs]

My favorite allergy is
Drug x----causes-------death
Her name was not Lazarus

 

[discharged]

When I was on my FM rotation, the attending spent less than a minute talking about the actual visit, and 20 minutes making small talk about life in general.

Sometimes during his rants, I would think about all of the school lectures on establishing relationships with patients... Then I remembered how useless of a role those first 2 years of medical school has played during my clinicals.

If I wanted to be Dr. Phil......... "If someone out there doesn't agree with me, then somewhere a village is missing their idiot."

 

[SserPrun95]

"15%- educational activities such as medical rounds" It sure seemed more like 250% of my day when I was forced to do it.

 

[la gringa]

Part of learning how to talk the patient is learning how to discern the BS from the real stuff, and learning how to make patients feel at ease... Some people are natural at this and it really takes a lot of work for others.

look at patient satisfactions scores... no matter how you feel about them in general, you can usually pick out who in your group would do well on them. still doesn't hurt to work on interpersonal skills.

 

[WilcoWorld]

look at patient satisfactions scores... no matter how you feel about them in general, you can usually pick out who in your group would do well on them. still doesn't hurt to work on interpersonal skills.

Then why do my scores vary by as much as 30% (from 100 one month to 70 the next, and then back) without my changing my behavior in any intentional way?

 

[TooMuchResearch]

My favorite allergy is
Drug x----causes-------death
Her name was not Lazarus

I did see "Adenosine - Reaction: Cardiac Arrest" listed on a pt's allergies. I blame the people that programmed the EMR to let anyone with a log in modify any section they please.

 

[la gringa]

Then why do my scores vary by as much as 30% (from 100 one month to 70 the next, and then back) without my changing my behavior in any intentional way?

don't know. mine have been 95-99% across 6 different hospitals in 2 groups in 4 years.

one thing i would point out is that if you have access to your surveys, read who fills them out and what they say. there are patterns.

 

[la gringa]

and, i have never done anything intentional for a "survey", only tried to diffuse a bad situation to avoid a complaint.... never gone overboard to generate an "excellent" or "5" or whatever. i do have partners who put on a dog and pony show.

i thank my parents and southern upbringing 😉 and pleasant countenance. i think i was born with at least a mild smile.

 

[Birdstrike]

"Dr. Feldman continued that 12 percent of time spent with patients 'seems shockingly low at face value.' "

12%? How do they find the time?

When they're attendings, they'll be lucky if it's 1.2% with all the requirements heaped on doctors now that have nothing to do with patient care, ie, defensive-medicine charting requirements, CMS/JACHO/Obamacare requirements, Press-Ganey errands, playing hospital politics, arguing with consultants, charting and other requirements to get paid by insurance companies, etc.

Fact: Spending time with patients is less than 1% of doctoring nowadays. This is by no fault of doctors.

 

[QuackaDO]

I think the whole key to this thing is perception... public perception. I wouldn't hesitate to say that most (probably all) of us know this is "normal" and nothing to be alarmed about but the obvious intent of the article was to raise the ire of the public with the thought that either A) Doctors don't care, B) Doctors don't see patients as something "important", or C) all the above. The public wants to feel like the doctor is babying them and anything less than that is lack of care/concern and indicates the doctor is doing them a disservice. We all know that's not true, but, just like how a patient perceives that the doctor does nothing but "sit over there and play on the computer", they have NO IDEA what the job actually involves or what we actually do. I don't really blame the patients per se... I mean I have to admit I get impatient anytime I stand in line thinking "WTF are they doing back there" when often times (or maybe sometimes, lol) the answer is simply "their job" and they have to go through as much BS as we do to get what would seem to be an outwardly simple task done. The only blame the patient has in this is not TRYING to be understanding that it's really not as simple as "ask and receive". The real fault, and what makes me the most sick when BS like this is brought up, is that of the people writing the article and the people creating the study to SKEW the perception of the findings as something negative. If ANYTHING should be taken from this article is should be this... "Wow, physicians have an AWFUL lot of BS to wade through and put up with just to get the job of helping the patient done. What can we do to minimize that BS and make "helping the patient" an easier and more effective task".

 

[Arcan57]

I blame the patients. I'd definitely spend more time with patients if they were more interesting as people. When I do indulge their desire to communicate with someone who is being paid well not to point out how a series of increasingly poor life choices has led them to needing emergency medical care, they either choose to vent about their unsolvable psychosocial problems or they believe that giving me every possible detail of their past decade of medical care will somehow make up for their complete lack of insight into their current disease process or ability to form a coherent response to anything more complicated then yes/no questions. YMMV.

 

[glorfindel]

If you want to spend time with patients, go into nursing. And I'll bet the nurses can tell some scary stories about how their own increasing non-patient-contact responsibilities.

 

[FSU2013]

I blame the patients. I'd definitely spend more time with patients if they were more interesting as people. When I do indulge their desire to communicate with someone who is being paid well not to point out how a series of increasingly poor life choices has led them to needing emergency medical care, they either choose to vent about their unsolvable psychosocial problems or they believe that giving me every possible detail of their past decade of medical care will somehow make up for their complete lack of insight into their current disease process or ability to form a coherent response to anything more complicated then yes/no questions. YMMV.

lol

 

[FutureInternist]

and most of the 4 pages was the allergy list(all cause anaphylaxis)...."water, steroids, epinephrine, sunlight, rhythm and blues music, cocker spaniels, green grapes, tylenol(but not vicodin or percocet, etc)

The number of allergies a patient has is inversely proportional to their mental stability !

 

[gutonc]

The number of allergies a patient has is inversely proportional to their mental stability !

I actually have a rule about this. >5 medication allergies, allergies to >3 classes of medications or allergies to >3 narcotics have a 95% sensitivity and specificity for an Axis II disorder. I did those calculations when I was an intern. If I were to re-run the numbers based on the last 6 years, I imagine the numbers would be closer to 99 and 99.

 

[dchristismi]

I blame the patients. I'd definitely spend more time with patients if they were more interesting as people.

Agreed.

And then, I'll get a sharp-as-nails 92 yo, and ask him if he was in the European Theatre or the Pacific Theatre.

I had a little old man launch into a story of the battle of Iwo Jima one day. It was incredible. I've never had someone start with an actual battle story until him. He was in the Navy, and talked about how the artillery was pounding their ship, and the bodies all around, and how the chaplains gave last rites, and they buried people at sea in the midst of it. And how he narrowly escaped a shell that wiped out all the other radio operators and spent the next 6 months "shell shocked" in hospital. It was incredible. The nurse and techs who happened to be listening in all just stopped. And we were all (including the patient) in tears by the time he paused. And yes, he was definitely thanked for his service.

That 28 yo fibromyalgeur? Not so much. And I rarely have the time to indulge in the above. But it's pretty damn awesome to be gifted with a story like that.

dchristismi's rule of thumb: if he's wearing a VFW hat, ask about it.

 

[docB]

Fact: Spending time with patients is less than 1% of doctoring nowadays. This is by no fault of doctors.

I don't know. I think the go along to get along attitude of our predecessors and us has doomed us to being menial functionaries in an industry we should control absolutely. We let this happen to ourselves and it may be too late to change it.

 

[WilcoWorld]

dchristismi's rule of thumb: if he's wearing a VFW hat, ask about it.

👍

 

[xaelia]

This is very concerning.

If the residents aren't spending enough time with patients, that means I might have to once in awhile.

That's unlikely to help our PG numbers.

 

[deleted109597]

It will improve throughput though.
Discharging patients without waiting for residents? 1 less hour per patient.