Never Let Them See You Sweat

One workday a few years ago, I had to be at a semi-formal family function by a certain time. Of course, of all clinic days, this one was even more hectic: multiple consultant phone calls, phone messages marked with “red flags,” letters that – for some reason – needed to be written on the day requested, and not one, but two people needed to go to the ER (one via ambulance). I drove as fast as legally possible to get to my relative’s house. Without having had a break to even go to the bathroom, it was difficult to sit in traffic. 

I got there eventually and was greeted with a slight reprimand for being late. OK. I expected that. But I didn’t expect the comment that followed. “What do doctors do, anyway? They spend just a few minutes with patients. Otherwise, all I see them do is talk to each other in the hallway.”

Leave it to family or close friends to push you off of your high horse (irrespective of whether you are on one or not). Not too long before this, there was a suggestion by an administrator of our clinic that we should increase the number of patients we see since recent changes in our EMR should have improved our efficiency. These two events made me wonder: Exactly how much time do I actually spend involved in patient care outside of seeing them? 

So, for the next few weeks, I used an online stopwatch and closely monitored my daily activities, recording how much time I spent on “indirect care,” including, but not limited to:
– refills
– patient questions on the phone
– phone messages
– reviewing consultant notes
– talking to consultants on the phone
– documenting/charting
– reviewing outside records
– filling out forms, including insurance authorizations and nursing home documents

(all of these tasks can require research into the respective patient’s chart)

Before you read on, if you are a patient, can you guess how much time this adds up to? If you are a physician, do you know exactly how much time this takes you? Have you ever tried to measure it? 

The answer for me:

4 to 4.5 hours a day. 

To clarify, I was the second most “efficient” physician in that moderate-sized practice, if not THE most efficient. And I was shocked by this number. I imagine that it would take 5-6 hours for docs who were not as efficient.

I do it despite the lack of reimbursement for the majority of these tasks. After all, it’s part of the overall care of my patients. You might not see such generosity, however, from other productivity-based-paper-pen-and-brain careers that lack fancy tools or equipment (accounting, law). What’s more, when nurses were phased out of primary care clinics, we lost some of the help with administrative tasks and some of the minor, more straightforward clinical work. Instead, primary care doctors were asked to “do more, in less time, with less help, and with less reimbursement.” It’s a part of medicine we often try to hide – rather than fix – and the part that medical students tend to avoid. That being said, I continue to practice in primary care because I still strongly believe in its purpose and I believe I am helping others… at least until a candid remark about physician “laziness” shocks me into the reality of a completely different perception out there.

While I work diligently to take care of other patients in between actual patient visits, I also work hard to give each person I physically see the amount of time needed to have him/her be heard and to be thorough. Though it sounds pseudo-therapeutic on some days, there is no such thing as a three-martini lunch, only a three-minute lunch. So, if I do happen to have the time to talk to a colleague, it is a nice reprieve. But twiddling my thumbs I most certainly am not. And, quite often, I think and worry about some of my sicker patients long after the clinic has closed….

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About Linda Pourmassina, MD

Internal Medicine physician.
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4 Responses to Never Let Them See You Sweat

  1. Gary Doi says:

    Thank you for that thoughtful article, Linda. I would be interested in reprinting it for my magazine blog “A Hopeful Sign”. http://ahopefulsign.com It is a popular blog about living-learning-leading. Your article would be well suited for the “learning” portion of the site.

    if you are interested, please reply by email.

  2. Thank you for measuring this (another unreimbursed use of time!) and saying it so eloquently: “twiddling my thumbs I most certainly am not”!
    The range of tasks I do as a family doc on a daily basis is crazy and only believable to another primary care doctor. Thanks for putting a number on it – I intend to use your data!

  3. Well put. It’s so clear to me that most people have no clue about the reality of a doctor’s life- especially primary care doctors. All they are really aware of is how the changes in health care have negatively impacted them. I believe we are partially responsible for this, because we choose to keep the relationship “professional” and don’t really share with them how out of control things have become. We are, in effect, protecting the insurance companies and government agencies by our avoidance of pointing fingers and placing blame. All of this said, I honor the doctors like you who are committed to their patients and still believe that what we do is valuable and meaningful. Thanks for what you do.

    • Yes, I do believe in the work of the primary care doctor and am saddened by the forces contributing to the shortage in this field. I tend to continue to keep perspective even when things get frustrating in order to best serve my patients and to care for them the best that I can. However, I won’t deny that human side of me gets a little taken off guard when there is verbalization of a poor perception of doctors. I do agree with you, Dr. Usander, that we (physicians) are partially to blame. Thank you for reading.

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