Time Spent with Patients: A Doctor’s Most Important Function

Know thy time.

Peter F. Drucker (1909-2005), The Effective Executive (1966)

October 28, 2012 - Sometimes what’s important hits us like a thunderbolt right under our noses.

I had a farm in Minnesota, 30 miles from my suburban home. My wife and I spent my day off and weekends there. A farmer of Czech heritage, Ladislav Malecha, took care of the farm for us. We would rush to the farm, then hastily rush back to the city. One day the farmer said to us, “What’s the rush? What’s more important than spending time with me?”

What indeed? Human beings judge their value to other human beings by time spent with them. Spending time with the doctor is what impresses patients. It is why they came to see you. Nothing irritates patients more than sitting idly in the reception or exam room, waiting for you. No more important use of your time than spending your valuable time with patients. What’s more important?

Other doctors, smarter and more insightful than me, have brought the importance of time to me over the years.

·         In December 2006, I wrote a series of 20 posts on how to build patient trust. The first blog post in series contained this paragraph.

 “Dr. Randall Oates, a family physician in Arkansas, for example, decided he would only see complex patients requiring a physician’s professional knowledge; he would delegate to staff all other patients being seen for other reasons. His decision made better use of his time and increased coding revenues."
 
Randall has since gone on to form an EHR company called SOAPware, which produces easy-to-use software that saves clinicians time.

·         In January 2010, I wrote a post with the title “Physicians Business Ideas for Practice Productivity: Why Not Let  Patients Enter Data””  The post chronicles the story of Allen Wenner, MD, of Columbian, South Carolina.  Wenner pioneered and developed software, consisting of patient-centered software consisting of patient-enterable clinical algorithms  wherein patient could enter their demographics, chief complaint, and history by answering simple “yes” or “no” questions.  The output was called the Instant Medical History. which saved the doctor 6- 8 minues of history-taking time with each patients.

·         In May 2010 in “Practice Interruptus: Those Invisible, Inevitable Interruptions,” I told the story of Wesley Curry, MD, a A California ER Physician.”  Curry said the computer was a big time interrupter.  He spend 2-3 hours each workday logging in, inputting, or requesting information, and logging out of 6 to 8 software programs that had become mandatory in the patient encounter. One program was for obtaining lab results, one for X-ray, one for discharge, one for recalling past charts, and so forth.  Each log-in or log-out required more time for getting through the various security screens which shut down the program if there was no activity  for a few minutes when the doctor is away seeing patients. Logging in or out takes at least 30 seconds to one minute for each program, and in aggregate takes a significant amount of time which could be used to see patients. These programs helped retrieve useful information and document  the encounter,  but Curry  asserted, had little value  in creating real time efficiency.  Electronic records were simply not clinically useful.   Curry’s solution was  to hire a scribe to follow him around,  entering information and opening and closing programs.

• · In January 2011 “In Saving Time and Practicing Better Medicine “ I commented at length:

“In The Successful Doctor: A Productivity Handbook for Practitioners (An Aspen Publication, 2000), Marshall O. Zaslove, MD, a West Coast physician who conducted productivity seminars for doctors, gave a few hints on how to save time while conducting a better, more productive practice.

1) Realize you’re the highest paid person in your practice, and you’re paid to see patients at the rate of $3 to $4 per minute.

2) You’re paid for your time and knowledge.

3) Spend your time with complex patients requiring your knowledge.

4) Delegate patients with simpler problems to physician assistants, nurse practitioners, nurses, and others.

5) Have patients in the reception room write down three questions that concern them the most. This will allows you to get to the heart of the problem quickly.

6) Look into acquiring instantmedicalhistory.com software. This allows patients to generate their own history based on their chief complaint, age, and gender, before or during their visit, saving you 4 to 8 minutes per patient visit.

7) Ask your nurse or other members of your staff how you can do things better and faster. Often they’ll tell you practical things they’ve been dying to tell you for years.

8) Don’t allow unreasonable interruptions while you’re working.

9) Avoid administrative committees, unproductive conferences, and meetings that waste your time.

10) Buy a 20 gallon wastebasket for your office. Immediately (and gleefully) toss clinically irrelevant paper items into it.

11) Be careful how you use the phone. It takes up to 1/3 of some doctors’ time.

12) Consider charging for patient emails, and substituting these emails for phone calls.

13) Consider hiring a scribe to record relevant historical information and to enter data.

14) Consider installing an EMR but not until it is ready for prime time, saves time, boosts productivity, and is useful for communicating with others.

15) Consider applications of mobile devices to increase productivity – look for successful examples.
I could go on, but I will not. Instead, I will circle back to the opening quote an enter these observations from Peter Drucker: “Time is a unique resource..The supply of time is totally inelastic. No matter how high the demand, the supply will not go up…Yesterday’s time is gone forever and will never come back. Time is, therefore, in always in exceeding short supply. Time is totally irreplaceable."

Tweet: What’s important to patients is to spend time with doctors. That is what is important to doctors too. Listed here are ways to create more time