The study, which followed 29 internal medicine interns for three weeks at Johns Hopkins and the University of Maryland, found that interns spend 12% of their time talking with and examining patients; 64% on indirect patient care—placing orders, researching patient history, filling out electronic paperwork; 15% on educational activities (e.g. medical rounds); and 9% on miscellaneous activities.
Though researchers have not identified an ideal proportion of time for interns to spend with their patients, Dr. Leonard Feldman, the study's senior author and a hospitalist at Johns Hopkins Hospital, said in a news release that 12% “seems shockingly low at face value. Interns spend almost four times as long reviewing charts than directly engaging patients.”
According to Feldman, it isn't just a matter of whether patients are getting adequate time with their doctors, but if interns are also receiving enough training with patients.
“One of the most important learning opportunities in residency is direct interaction with patients,” Dr. Lauren Block, a clinical fellow in the division of general internal medicine at the Johns Hopkins University School of Medicine and leader of the study, said in the release. “Spending an average of eight minutes a day with each patient just doesn't seem like enough time to me.”
Similar studies from 1989 and 1993 showed that interns spent between 18% and 22% of their time at patients' bedsides. Even so, two decades ago, interns were still allocating more of their time to documentation than to actual patient interaction.
“It's not an easy problem to solve,” Feldman said. “All of us think that interns spend too much time behind the computer. Maybe that's time well spent because of all of the important information found there, but I think we can do better.”
One of the ways study researchers suggested reducing that time is through the use of improved electronic medical records, as well as grouping an intern's patients together in the same area so as to reduce transit time between patient visits.
The study, published online in the Journal of General Internal Medicine, was funded by the Osler Center for Clinical Excellence at Johns Hopkins and the Johns Hopkins Hospitalist Scholars Fund.
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