The Value of Time with Patients
Sept, 2019: I hate to admit it, but I have become a bit addicted to Twitter as of late. This addiction comes at a cost. While intentionally steering clear of all things political, I still find myself stumbling into on-line Twitter wars with people in far away countries and here at home without trying to at all. Just re-posting an article with a harmless (or so I thought) comment can initiate an international battle royale. I have found firsthand that when it comes to medicine and healthcare, the Twitter lines are clearly drawn.
For physical therapists, the lines are clear: the manual physical therapists on one side vs the exercise-only physical therapists (don’t they know that most patients need some of each to get better??). Even if you aren’t squarely in either camp, make one comment and the Twitter regime will assign you to one without asking. For other healthcare professions as well, there are clearly drawn lines between the status quo, the newly emerging research followers, and those who don’t even know which they are (they’re probably not even on Twitter). There are even battles about whether medical professionals should be on Twitter, or whether all medical information should only be divulged through professional journals and in-person conferences (yes, this group may have some silver in their hair). But then again, there are the medical professionals on-line who clearly are in it only for popularity- the likes, the follows, the pages views, and the profile hits. These folks probably don’t hold true to much of anything, but rather forward links to new info on anything related to health without granting much in terms of opinion or additional depth on the issue.
Recently, however, arguably the hottest medical topic on Twitter is really no debate at all, but rather a cold, hard fact. A recent report found that only 12% of a physician’s time is spent with a patient. The rest of the typical physician’s day is spent documenting each patient visit in the EMR (electronic medical record), searching for items in the EMR, answering phone and on-line messages, doing orders and authorizations for procedures and medications, and meetings. What does this mean for patients? What is the overall impact on the quality of the healthcare? But interestingly, what is the impact on physicians- on their job satisfaction and their feeling that they can make a difference in their patients’ lives?
The change has been brought about by extra mandates by government and insurance sources on what needs to happen at each physician visit, and what additional items need to be reviewed and documented at each patient visit, regardless of the reason for the visit. These items take up significant time, as does simply documenting in front of the patient, taking away face time and hands-on assessment time. Another change is the amount of time each physician has allotted to each patient visit. Obviously, some visits (new patient visit) will take longer than a quick re-check to determine how well a new medication is working. However, health systems mandate a specific number of patients to be seen each hour. With our current physician shortage, there is no way to give enough time to each patient. And the EMR that was supposed to save us all time has instead increased the burden of documentation to also feed the appetite of big data gatherers who are growing statistics on population health.
For patients, this change can result in poorer quality care. Unless a physician bucks the system (and the good ones will resist), visits are short, patients feel rushed, and there is no way that every question can be answered. For physicians, they are fatigued, over-worked, burned out, and finding that their career originally focused on helping people is now a more intimate relationship with their computer, pager, iPad and phone.
As I read these statistics and reflect on how I practice physical therapy, I am so thankful that I founded MotionWorks Physical Therapy six years ago to maintain as our first and foremost goal of providing the highest quality of physical therapy care in the Fox Valley. Good quality takes quite a few things, but first and foremost requires the gift of time. At MotionWorks we really do take the time that each patient needs. We recognize that some patients may need 30 minutes, while other, more complex patients may require full hour visits to meet our treatment goals. We also encourage our physical therapists to document in the most efficient way possible, some times being in front of the patient, and some times following the appointment later in the day. Finally, we encourage hands-on, individualized care for each patient, so the specific needs of each patient are met. This is the only way that we can deliver on our promise to get our patients better, faster.
The only constant in life is change, and nowhere is that truer than in healthcare. As physician and allied healthcare provider shortages are anticipated to only increase in the coming years, MotionWorks Physical Therapy is dug in and committed to our mission and our values. We seek to be flexible to meet the challenges that lie ahead without sacrificing what inspired us to become doctors of physical therapy in the first place, to enhance the health and well-being of our patients.