Ask Dr. Jon Hallberg: Study says medical interns spending less time with patients
Doctors in training are devoting fewer minutes to doctoring. That's the topic of our discussion with Dr. Jon Hallberg.
The medical community has been talking about a study out of Johns Hopkins University that found medical interns are spending 12 percent of their time with patients. What were they spending their time on? It turns out a lot of it involves entering data on computer terminals.
Hallberg, a regular medical analyst on All Things Considered and a physician in family medicine at the University of Minnesota, spoke with Steven John of MPR News. The following is an edited transcript of the conversation.
STEVEN JOHN: Tell us about this study. Where did it come from?
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JON HALLBERG: It was published in the Journal of General Internal Medicine. The study looked at 29 internal medicine interns. These are people in their first year of training after medical school. They followed them for three weeks for a total of 873 hours, basically following their every step of the day while they were in the hospital.
JOHN: What surprised you about it?
HALLBERG: There was a study that came out in 1989 and again in 1993 that showed how much time we were actually spending time in training, directly with patients, and it was about 20 percent of the time. Now we're down to 12 percent.
As people have gotten sicker -- I mean, let's face it, if you're in the hospital these days you're probably a sicker patient than you were 20 years ago -- we're actually spending less and less time, and it sounds like the majority of that time was spent on the computer.
JOHN: Why is that? Are they required to submit more data into servers someplace?
HALLBERG: When I was in training in the early '90s you would write orders on a sheet of paper. You would write a quick note in the chart. It was handwritten, it was pretty quick, and frankly it could be rather cursory.
Now what's happened with electronic records -- partly for billing purposes, partly for documentation purposes -- it has just become a very cumbersome process. There's no simple, super-quick way of doing it.
JOHN: Is this a growing trend then in the medical profession, not just interns and residents?
HALLBERG: Sadly so. It's not as though the amount of people we're seeing in a given day has shrunk. The amount of documentation that's needed for every encounter has increased. And there's only so much time in the day. And so people are finding all kinds of ways of making it go quicker.
I think the notes are becoming less about the person. When a person has lots of different things that don't fit nicely and neatly into a template that can be clicked, your heart kind of sinks because you have to think of a way to capture that encounter that is not very amenable to the electronic record.
JOHN: So you are spending more time as a practicing physician in front of a computer than you used to?
HALLBERG:Oh, my gosh, yeah. Both with the patient in the room and then after the fact, into the evenings and weekends as well.
JOHN: Is it possible to make the computer screen time integrate with the patient experience, for instance, pulling up old data and discussing their symptoms in previous visits to the ones they're experiencing now?
HALLBERG: Absolutely. That's one of the great things about it. You can graph a patient's blood pressure readings for the last year and see the trend. One of the most useful things is to find a person's weight when they come in and show that they've lost weight, or gained weight.
And that's kind of taking advantage of the fact that the computer puts all that stuff together for us. It's just the entering of it that's so tricky.
JOHN: Where do you think this trend is going?
HALLBERG: It's certainly not going away. It's only going to become more and more a part of what we do.
To me, this sort of holy grail of electronic documentation would involve something other than a keyboard and something other than a mouse. More touch-screen capability. There has to be a way of -- when I say a key phrase for example -- of documenting that and sort of auto-populating the chart as I'm doing the encounter in real time.
