At the 45-bed hospital in rural Alaska where Dr. Janice Boughton is a hospitalist, her shift starts at 7:30 a.m. Here’s what greeted her when she arrived one recent morning:
The night shift doc told me about the 13 patients who I needed to take care of that day. Seven of the patients were new to me, admitted the night before. For those patients, I needed to review their medical histories in the computerized medical record and get to know them, with a focused physical exam and an interview to determine what needed to be accomplished in the hospitalization. For all of the 13 patients, I needed to review all of the lab tests completed in the last day and all of the radiological studies and check their vital signs and review the nurses’ notes about what had happened in the previous 24 hours. Each person had an average of about 30 blood test values and some of them also had microbiological results that needed to be reviewed.
And the day had barely even started.
For the next 12 hours she saw patients, reviewed tests and medications, dictated notes, updated medical charts, admitted two new patients from the emergency room, transferred two patients out of intensive care, answered the phone, did five bedside ultrasounds, talked to patients and families about end-of-life care, discharged patients who were ready to go home, discussed patient care with referring physicians and tried to track down incomplete test results from a pathologist.
No wonder doctors become frazzled by the amount of multitasking they’re required to do. “I love every little part of my day, but I don’t necessarily love trying to do all of it at the same time,” Dr. Boughton writes.
Perhaps it’s no coincidence that around the same time Dr. Boughton wrote about her hectic day in the hospital, JAMA Internal Medicine published a survey that uncovered serious, quantifiable issues with the workload that many hospitalists experience.
Just over 500 hospitalists from across the U.S. took part in the survey, which was conducted online. Among the findings:
- 40 percent of the respondents said their patient load exceeded safe levels at least once a month, and 36 percent said this happened weekly.
- One in four reported that the excess workload often resulted in being unable to fully discuss treatment options with patients and families or answer their questions.
- About 25 percent said their workload affected patient care.
- 19 percent felt the heavy workload was detrimental to patient satisfaction.
The overload isn’t limited to hospital medicine. Nurses worry about high patient-to-staff ratios and the impact this has on patient care and safety. A study that looked at pharmacy workloads found that when pharmacists were overloaded, there was increased potential for error.
And when researchers tracked the workload at a private internal medicine practice in Philadelphia a few years ago, they found some startling statistics on how the physicians spent their day. Each of the five doctors saw an average of 18 patients per day, made 23.7 phone calls, received 16.8 emails, processed 12.1 prescription refills, and reviewed 19.5 laboratory reports, 11.1 imaging reports and 13.9 consultation reports.
It’s a recipe for harried providers, frustration, mistakes and ultimately professional burnout.
None of this is good news for patients who increasingly are having to make do with a smaller slice of the doctor’s time and attention.
Patients can help reduce some of the overload by being organized and focused when they talk to the doctor. They can help by knowing their health history and what medications they’re taking. They can quietly grit their teeth and be patient when a phone call isn’t promptly returned. They can show up on time to their appointment, because even though doctors are often late, the schedule gets further clogged when patients arrive late too.
This is only a fraction of the solution, however. Moreover, there’s a limit to how much should be expected of patients to help reduce the doctor’s workload. There are times, after all, when someone genuinely needs the extra attention.
No, the real problem lies with the system itself. Perhaps even more than cost or quality, clinician overload is a major – and often ignored – issue that threatens to swamp the progress toward better, safer care. And the near future doesn’t seem to hold many fixes.