Sunday, January 9, 2011

Saving Time and Practicing Better Medicine

The supply of time is totally inelastic. No matter how large the demand, the supply will not go up. Moreover, time is totally perishable and cannot be stored. Yesterday’s time is gone forever and will never come back. Time is, therefore, always in exceedingly short supply.

Time is totally irreplaceable. Everything requires time. It is the only truly universal condition. All work takes time and uses up time. Yet most people take for granted this unique, irreplaceable, and necessary resource.

Peter F. Drucker, 1909-2005

Don’t take time for granted. Doctors may have less of it under the new reform law, with more regulations to meet and more patients to serve. Time will be more precious, and there may be less of it. That is why some doctors are switching to concierge practices, so they can spend more time with patients.

According to the Physicians Foundation, a charitable 501C3 organization representing doctors in state medical societies, health reform ought to be about freeing up doctors to spend more time with patients. Health reform ought not to be thought of as root canal changes forcing doctors to comply with federal regulations, document every action, and restrict their time with patients. Already some doctors spend as little as 7 minutes for each patient to make ends meet.

Societal and economic trends are towards more accessible care at lower costs These trends are pressuring doctors to make better use of their time and resources, to give more bang for the buck. Pressures are both “informal,” coming from the health care marketplace, and “formal,” emanating from the new reform law.

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 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

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