How Much Time Should Doctors Spend With Their Patients?
(From 2022, when Epic was my EMR)
I wonder if there is a difference between older and younger physicians when it comes to how much time we actually spend and would prefer to spend with patients. In 1984, fresh out of residency, I was the young man trying out a position in Livermore Falls, Maine. The two fifty-something family docs wrote their notes by hand standing up at the counter in a shared area. There wasn’t a whole lot of other paperwork to do.
Now, I read statistics from the American Medical Association that doctors spend more than 50 percent of their time with their EMRs, which at least to a degreee means away from their patients. I guess I’m a little slow, but it’s finally becoming clear to me why I am always behind on my charts.
Being old school, I have little patience for the fact that I am expected to tear myself away from my patients – worried, suffering fellow human beings – because the technology I’m required to use is pathetically clumsy and obviously not created by people like me who know and respect what I need in order to help my patients.
In the early years of my practice, nurses and medical assistants, like veterinary technicians today, were allowed to give medical advice and order tests based on common practice, verbal orders or “common sense”. In my Epic EHR, I have to “touch” everything, down to signing off on a “conversation” after my nurse has done what I asked her to do. And only I am allowed to give advice that any available grandmother would have dished out instantly and free of charge – if people had them around anymore.
I feel I’m in a culture clashing time warp.
How understanding can we expect patients to be when half of the time they hoped to spend with us, we’re interacting with a machine, ultimately for their benefit, but often in ways that are invisible to them.
I grew up before there were computers, smartphones or EMRs. But yet I think I’m more impatient with their inadequacies than younger providers who grew up playing video games. Not that I quite understand why they’re more tolerant of bad technology than I am, but I guess I expected that the future would bring more seamless, unobtrusive technology than it actually did.
And, speaking of computer games, compare them with today’s pathetically stilted EMRs - more on that tomorrow…
I am old enough to have had doctors with whom I had a personal doctor/patient relationship, who knew me well. We have a serious shortage of doctors where I now live in New Mexico. Aside from the first doctor that I was lucky to get when we moved here eight years ago, who, because he had his own personal practice, spent time with me and worked to fine tune treatment, who spent no time looking at a computer, but spent time with me, my experience with doctors here has been reading about conversations we never had, in my medical charts that I can look up online after the visit. I’m sure that they had to tick certain boxes in order to get whatever they’re rewarded by showing that they covered something, but I’m always surprised at what I find that is news to me. When wearing a Zio patch requested by my new doctor revealed SVT (a family inheritance: grandmother, mother, brother, me, son), I was sent a note by said doctor to make an appointment with a cardiologist. No referral, no suggestion. From experience, I chose the one electrophysiologist in the group’s practice and got an appointment on a cancellation, two months away. (I’m not worried about its occasional appearance.) I’ve been told that for most issues, to go to Urgent Care, not try to get an appointment with her, and after ordering the normal battery of blood tests, set up an appointment to see her again in a year’s time.
I worked for a health services research company in Michigan for the last 18 years of my working life. Our company was instrumental in helping the State initiate an electronic medical system many years ago. We all thought it would be the answer to everything. Well, here in NM, I have MyCharts with five different medical systems because of doctors being in one or another, and only two are connected. (Christus Health Care, Presbyterian Healthcare, Southwest Care, Quest Diagnostics, X-ray New Mexico.) I have to supply missing information from the other entities, IF the doctor is interested. I haven’t found any to be interested in my past medical history, (though most of it is benign). I often have to remind outside sources (bloodwork and x-rays) to send the reports to the doctor who ordered them. Sometimes, more than once.
I miss the first doctor that I had here who spent time with me. He retired. The second doctor that I had never once examined me in the six years I was his patient. He ordered tests, he talked to me above his computer and made suggestions. He left the State when his kids reached school age. We’re rather at the bottom of the list in education in this State. I had a nurse practitioner for a year before I got an appointment with this new doctor who is also a geritonologist. It took a couple of months and I lucked into a cancellation. We couldn’t get my husband in for 6 months so he hasn’t seen her yet. I like her well enough but it’s definitely doctoring by data management. It’s what it is in our neck of the woods these days I’m afraid. My husband and I figure that we have one more move in us if we are fortunate to live into our 80s (we’re in our 70s now) to live where there is better medical care. We live in a beautiful area of NM but at some point our health will have to take precedence. At least we’re not in any danger of being over treated here. And I do want to give a shout out to the excellent orthopedic care and surgery that i had here. My new hip is the cat’s meow and I’m very grateful.