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Doctors-in-training spend very little time at patient bedside, study finds
Date:4/23/2013

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's 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, Feldman says, "seems shockingly low at face value. Interns spend almost four more times as long reviewing charts than directly engaging patients."

Studies in 1989 and 1993 found that interns still spent more time documenting than seeing patients, but they spent between 18 and 22 percent of their time at the bedside. In those studies, however, researchers found that a large chunk of time was spent sleeping at the hospital, something rarely seen today. Reduced intern work hours were designed to lessen trainee fatigue and improve patient safety.

Feldman says questions raised by his study aren't 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 aren't lost, the researchers say.

"As residency changes, we need to find ways to preserve the patient-doctor relationship," Block says. "Getting to know patients better can improve diagnoses and care and reduce medical errors."

The researchers say better electronic medical records may help reduce time spent combing through patient histories on the computer. Another improvement cou
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Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medicine
Source:Eurekalert

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