Very Little Time at Patient Bedside -- MEDICA - World Forum for Medicine

Medical Interns: Very Little Time at Patient Bedside

Photo: Doctor at computer

Medical interns spend 12 percent of their time on direct patient care, and more than 60 percent on placing orders, researching patient history or filling out paperwork;
© Davies

Medical interns spend just 12 percent of their time examining and talking with patients, and more than 40 percent of their time behind a computer, according to a new Johns Hopkins study.

Indeed, the study found, interns spent nearly as much time walking (7 percent) as they did caring for patients at the bedside. Compared with similar time-tracking studies done before 2003, when hospitals were first required to limit the number of consecutive working hours for trainees, the researchers found that interns since then spend significantly less time in direct contact with patients.

"One of the most important learning opportunities in residency is direct interaction with patients," says medical doctor Lauren Block, a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine. "Spending an average of eight minutes a day with each patient just does not seem like enough time to me."

For the study, trained observers followed 29 internal medicine interns - doctors in their first year out of medical school - at John Hopkins Hospital (JHH) and the University of Maryland Medical Center for three weeks during January 2012, for a total of 873 hours. The observers used an app to mark down what the interns were doing at every minute of their shifts. If they were multi-tasking, the observers were told to count the activity most closely related to direct patient care.

The researchers found that interns spent 12 percent of their time talking with and examining patients; 64 percent on indirect patient care, such as placing orders, researching patient history and filling out electronic paperwork; 15 percent on educational activities, such as medical rounds; and 9 percent on miscellaneous activities. The researchers acknowledge that it is unclear what proportion of time spent at the bedside is ideal, or whether the interns they studied in the first year of a three-year internal medicine training program make up the time lost with patients later in residency. But 12 percent, medical doctor Leonard Feldman, a hospitalist at JHH, says, "seems shockingly low at face value. Interns spend almost four more times as long reviewing charts than directly engaging patients."

Feldman says questions raised by the study are not just about whether the patients are getting enough time with their doctors, but whether the time spent with patients is enough to give interns the experience they need to practice excellent medicine. With fewer hours spent in the hospital, protocols need to be put in place to ensure that vital parts of training are not lost, the researchers say.

"It's not an easy problem to solve," Feldman says. "All of us think that interns spend too much time behind the computer. Maybe that is time well spent because of all of the important information found there, but I think we can do better."; Source: John Hopkins Medicine