The Annals of Family Medicine is becoming one of my favorite journals. I been very impressed with the quality of the papers published their and as soon as they get RSS feeds (I lobbied Kurt las month about this) we will be all set.
The article about time that physicians spend with their patients is interesting to me because it seems that most physicians spend rather little time with their patients even though the paper suggests that the results revealed that physicians actually spend more time with patients than was previously thought.
I'm certain that I spend much more than 50% of my day in the exam room .. and my day is certainly longer than 8.6 hours
Another very interesting article in this issue looks at the time that physicians spend outside of the examining room.
The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records
It would be interesting to see how things looked for practice with electronic medical records. I think that Paul Chang did some work on this subject in the late 1980s. Until we get to the sort of usability improvements that we really need, I expect the electronic medical records will improve efficiency only marginally.
Finally, our old friend Brian Alper (who has finally been able to get his life work, Dynamed – into the mainstream) has a very good paper that reviews the clinical utility of such a resource. I understand that Brian has improved the usability of Dynamed quite a bit recently. the information indicted that is quite good and Brian keeps it up to date almost single-handedly. He's been doing this since he was a third year medical student and his resource is certainly competitive with other products that cost much more. Ideally, a resource such as Dynamed would become integrated within the electronic health record.
But that's "web 2.0" whining all over again. a promise. No more today.