In Clicks vs. Checks, the Computer Is Winning Over Doctors' Time

Studies show it’s not just a bunch of doctors complaining about change and technology. If not addressed, the extra demands on a physician’s time can lead to extra stress and eventually burnout.

Physicians know technology has become a constant companion, and there’s some research showing just how much it has changed the flow of the workday and the doctor-patient relationship.

A study published by the American College of Physicians says internal medicine physicians at a Swiss hospital spent about three hours using a computer for every hour they spent with patients.

Another study from the Annals of Internal Medicine says the ratio was about 2:1.

Either way, that’s a lot of time.

The computer often can seem like the third person in the examining room, says Yul Ejnes, MD, a Cranston, Rhode Island, internist and member of the American Board of Internal Medicine’s board of directors. “Depending on the typing abilities of the physician, they may look you in the eye or they may have to look at the keyboard,” Ejnes says.

It also takes time and can interrupt the flow of a conversation between doctor and patient. “Every click takes a second or two,” he says, and those seconds become minutes and eventually hours. “It’s a much more cumbersome way of doing things.”

There are benefits, though. “It’s not all bad,” Ejnes says, adding “there are some things we can do better now than we could do then. Being able to find things is much easier, having a computer in the room instead of the thick chart in the room.” Ejnes says it is also helpful to have electronic access to patient records after hours or on weekends.

But the electronic health record doesn’t always live up to expectations. “When a patient comes into an office, there is an expectation the physician they’re in the room with is able to access everything,” Ejnes says.

He uses an ATM as an example of a way to explain what the EHR can and cannot do. No matter where a person is in the world, he or she usually can put an ATM card into a machine and see bank balances and retrieve money, because most ATMs can access a specific financial network. That isn’t always the case with an EHR; medical systems don’t always talk to each other. Explaining those limitations to a patient often takes even more of a doctor’s time, he says.

These types of studies about how physicians spend their time can be vindicating, Ejnes says, because most people in the industry know medical professionals were spending increasing amounts of time using computers, but there was no data to support it. Now there is. “This is a real problem, it’s not just a bunch of doctors complaining about change and technology,” Ejnes says.

If not addressed, the extra demands on a physician’s time can lead to extra stress and eventually burnout.

There are ways to make things easier, mostly by using team-based care: “Figuring out who can do what and not assuming it all has to be done by the physicians,” Ejnes says.

Scribes are one solution. Working with EHR system manufacturers to create programs that automate some tasks and require fewer clicks is another. Decisions need to be group-based, too. “A lot of time, these systems are not chosen by the front line physicians,” he says.

No matter what, the stress a physician feels shouldn’t translate to the patient. “Whatever headaches we’re going through, we try to keep the patient as protected from it as we can,” Ejnes says.

He says it’s also helpful to remember because of this additional effort, patients can access some of their records online and send emails using secure patient portals, eliminating the need for them to call the office. “Where the coordination does work and the data is being exchanged, it’s beneficial to the patient,” Ejnes says.

Tiffani Sherman is a freelance writer based in Florida.