02 April 2010

Friday Flashback

What I do with my time

I see, on average two patients for every hour I work, give or take some. This is about average for ER docs in general. I am a little on the fast side for our group. This breaks down to about 30 minutes per patient; simple patients take much less, while complex or critical patients take substantially more. Yet when we review patient complaints, one of the most common themes is "I only saw the doctor for a minute." I think that's a underestimation, but not too far off the mark. A complex patient, I may be with them on and off for half an hour, cumulatively. Moderately complex patients I may spend five to ten minutes at the bedside. Ankle sprains and simple matters may truly get a minute or two, depending on whether they need much in the way of instructions.

So, you may wonder, what is it I do with the other 25 minutes for each patient? Here are the common tasks (in no particular order):

  • review old medical records
  • enter orders in the computer, and via the unit clerk
  • write up the chart -- history, exam, medical decision-making
  • chase down labs
  • chase down x-rays
  • call answering service to page primary care doc, consultants, admitting docs
  • wait for call-backs
  • phone conversations with primary care doc, consultants, admitting docs
  • receive phone call from outside doctor or clinic
  • base station control for ambulances
  • conversations with nurses (patient care-related)
  • conversations with nurses (social)
  • write up discharge instructions and prescriptions
  • field phone calls from pharmacies about prescriptions written by other providers
  • write up admitting orders
  • bother charge nurse about when inpatient beds will be ready
  • visit bathroom (maybe)
  • follow up abnormal culture results
  • consult with psychiatric social worker
  • dictate records in some cases
  • fend off approximately 24 interruptions per hour (really)
  • eat (maybe)
So, yes, I am sorry that I only had a couple of minutes to spend with you. I know you spent a long time in the ER waiting for the test results, and you felt cheated that I was in and out briskly. I tried to communicate a lot in that short time and maybe you didn't follow it all. There are so many things to do that I wonder how I manage as it is. I can't omit (or escape) any of the above tasks, and I routinely go an entire shift without eating and sometimes without voiding. It's not as if I was lazing around. But you didn't see any of it, and you overheard an extended personal conversation between two nurses in the hall, so you have concluded that we were all too busy socializing to take care of patients. That is very frustrating, I understand. 

But we are, after all, very busy.

Originally posted 30 April 2007


  1. I can appreciate your situation. As a pharmacist, patients are consistently irritated and ask why it takes me 15 minutes to fill an rx.

    I actually had one guy ask exactly what I do that would take that long (during an EXTREMELY busy day). I brushed him off by telling him it would take me hours to explain what I do which was a result of my four years of pharmacy school & please sit down so I can fill your rx correctly in the 15 minutes I told you it would take!

    Even pharmacy techs often don't "get it" when I take time to check rx history, call offices, do the math to check a dose, etc. They just robotically type & fill the rx & want me to check it "because the patient is waiting". Heck - it takes me longer to fill my car with gas! I usually tell them they can have it fast (take it somewhere else) or correct, but they don't get to make that choice if they give it to me.

    I've decided its difficult to explain the cognitive function of my job, so I've given up trying. Surveys will always be skewed to those who have a bone to pick, which is why I ignore them. Sadly, my employer doesn't, but at least doesn't use them against me - yet.

  2. At the ED I scribe at the doc will usually see 20 pts during the 4pm to 11pm shift ('bout 3 per hour). Always have to bring a cliff bar b/c there is never time to stop and eat. In the past 7 shifts I've taken one bathroom break.

  3. Unconscious or deeply demented patients are the very best because they never complain about your time at the bedside.

  4. I've been in the ER twice in the last five years for allergic attacks, and in both cases, the doctor attending was there long enough to do his/her job. I was impressed at the rapid assessment they did; the care they provided was outstanding. That's been my experience - but then, I don't go to the ER unless it's an emergency. My mother, a former ER/surgical nurse, would kill me...

  5. It's always interesting to read your perspective on things like this, Doc. It sounds like you ER guys could really use a lot more clerical staff people just to fill out all the paperwork and answer phones.

  6. Okay, so now when I get someone admitted who has a hx of neurogenic bladder, I won't automatically ask if he/she has been a nurse, I'll ask if that person was an MD ;)

    Why do patients think that healthcare providers never need to take breaks, pee, eat.......

    Janene, RN

  7. As a Phone advice nurse I try to expain the process as a picture story. This works the best with guys, but your average person can understand.
    "Just like your car when it is broken down, the mechanic has to lift up the hood, poke around, do a bunch of tests,do the diagnostics over and over again until he figures out the problem. In the same way, medicine is not an exact science (even though we wish it were) and sometimes it takes the elimination process to get an answer,whichh can sometimes take time....There is no "magic wand"... and sometimes the answer to your problem is "I can fix it" or it is "Sorry, unless u can get a new part, you will have to live with it"
    I can almost hear their brain over the phone go..."Ah-ha...."

    I also often get " I am going to go in there and they are going to send me away without doing anything" to which I reply " Isn't that what you want? To have them tell you that you are OK and you can go home? Or would you rather them say you are deathly ill and in need of X-Y-Z??"
    They usually agree.

  8. I recently was doing a science demonstration that went terribly wrong. (CO2 bomb for the kiddies, went off early, blew >off< my safety gear and then sent shards into my left eye with a second concussion. Ow.) Immediately went to the local ER and was seen - while quickly - compassionately and kindly. As a patient, I know you guys are busy. For all the ones that complain, I just wanted to let you know that there are a few of us out here who are genuinely thankful for your time. (I thanked my doctor at the time, too.) Seriously, thanks.


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