It’s 6pm and time to go home. The primary care physician, who still has several hours of work to do, packs up her laptop and heads out the door. I’ll have dinner with the family and then do my charting after the kids go to bed, she reasons. From 9p-11pm most nights her husband can find her typing up the day’s clinic notes and working down her seemingly endless worklist. He tells a friend “its nice to have her home, it would be good to have her present.”
Do you think this scenario is unusual? Over the past several years I’ve had the opportunity to shadow primary care physicians (PCPs) and their teams across the country. One physician I shadowed, who despite being impressively facile with clicking, scrolling and smart-phrases, observed, “my notes take longer than my visits.” Many physicians leave the office with undocumented charts hanging over their heads, knowing they will have to be done at home after the kids are in bed or on the weekend.
Work after work: One organization has data that 30% of their PCP’s work is done between 7p and 7am. Not exactly the ticket to job satisfaction and retention. Another organization found that their PCPs spend only 20% of their day with patients, while half of their time was spent on the computer.
Physicians like geriatrician David Reuben of UCLA and ER physician Marian Bednar of Texas, described by Katie Hafner in the New York Times today, or Drs. Mary Parsons, Joe Kim, Peter Anderson, Charlie Burger, Amy Haupert, and Kevin Hopkins described in an Annals of Family Medicine study for which I was a co-author, are pioneers, exploring a better way, a way to take back the night. By delegating much of the record keeping of medical care to trained assistants (nurses, medical assistants or scribes) these physicians have found a way to more fully attend to their patients, be present to their families during the “off-hours” and reclaim some of the joy in practice. Bravo!