Eight minutes: this is approximately (1) how long it takes sunlight to reach the earth; (2) how long it takes to hard-boil an egg (if you eat them) and (3) how long medical residents — doctors in training — spend with patients per day on average.
What’s more, researchers from Johns Hopkins University and the University of Maryland have found that those eight minute are less than the amount of time that residents used to spend with patients (and make the standard 15 minutes allotted to a medical office visit seem generous).
Medical Residents Spend Minimal Time Interacting with Patients
In the 1980s, researchers discovered that residents were only spending about twenty percent of their time with patients. The rest was consumed with paperwork, drawing blood, inserting catheters and other tasks that did not have to be done by doctors. The residents also spent some time attempting to sleep, which, given they were working the 28-hour sessions standard for medical residents, was physically necessary.
As a result, a New York State Commission limited the number of hours that residents could train in hospitals to 80 hours a week. In the past, the norm had been for residents to work 100-a-week shifts — or even 120-a-week shifts – with 36-hour sessions.
In 2003, another change — residents could work no more than 24 consecutive hours — was made by the Accreditation Council for Graduate Medical Education with a view to cutting down on the fatigue and stress doctors-in-training experience and, also, the errors they made. Residents could no longer work consecutive days and periods of rest were required. Hospitals where residents trained had other hospital staff perform tasks such as starting I.V.s.
New Study Shows Efficiency Has Become “Overriding Concern”
The new study in The Journal of General Internal Medicine suggests that these efforts to reform medical residents’ training have had unintended consequences, neither to the benefit of patients or future physicians.
After studying medical interns at two training programs for almost 900 hours, the researchers discovered that the new doctors were only spending about 20 percent of their time in face-to-face interactions with patients — about eight minutes. What residents did devote a great deal of time to were duties only “indirectly related to patient care,” with much of this spent in front of the computer to read patient charts, write notes and enter orders. Residents also consulted with other doctors and transported patients (and ate and slept).
As Pauline W. Chen, M.D., writes in the New York Times, “efficiency has become an overriding concern” in the training of residents:
Young doctors required to see the same number of patients in less time try to speed up their work by culling from computer records all available information about patients, their symptoms and even their physical exam before seeing them in person. When finally in a room with patients, they try to speed up their work again, but by limiting or eliminating altogether gestures like sitting down to talk, posing open-ended questions, encouraging family discussions or even fully introducing themselves.
The mandatory limits to how many hours residents can spend on duty have had an effect on patient care. Another study published in March of this year has found that new doctors are now reporting more mistakes, insufficient sleep and symptoms of depression.
Patient Care is Being Compromised
Given that the experiences of medical residents during training have been linked to their future work as practicing physicians, the findings of these studies are hardly heartening. The biggest concern that the authors of the latest study raise is the effects on patient care: the less time a physician spends interacting with patients, the less they are able to detect symptoms or signs of disease.
For these reasons, I’ve found myself preferring to see a nurse practitioner who can spend time talking and why I understand why some of my students are foregoing medical school and instead studying to be physician’s assistants. They definitely want to be in the medical profession and care for patients but (along with the astronomical costs), the current state of training to be a physician does not seem to be in the best interests of our health, let along that of the doctors. As doctors advise and make decisions about nothing less than our health, the thought that they are doing so on the basis of so little actual face-to-face time is a concern to us all.
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