Increasingly I find my colleagues documenting time in patient charts. While there is little uniformity in the reporting (can you include time talking to the family, reviewing lab results, discussing the case with a colleague?), a streak of creativity is bubbling to the surface. I’ve seen statements like:
“I spent 31 minutes 12 seconds in direct care. This does not include time spent documenting the care delivered to the patient.”
“I spent 12 minutes reviewing tests, 8 minutes talking to the patient, 4 minutes examining the patient, 5 minutes formulating a care plan, 4 minutes talking to the nursing staff, 1 minute talking to a social worker, and 6 minutes documenting all of the above. Total time: 40 minutes.”
There is quite a lot of irony and a tinge of anger in these notes. A reasonable person might ask whether any of this reporting actually translates into better outcomes and better care. What about the quality of the time spent on patient care? Does that matter, and if it does, is there any way to judge it? At the end of the day, the time clock is just an artificial billing metric. Another example: When we try to define a high-complexity level 5 patient, it’s about making certain all the requisite categories are covered, not whether the patient is truly complex from a medical perspective.
These metrics simply bear no resemblance to reality. We’ve allowed the day-to-day practice of cardiology (and medicine in general) to devolve into an exercise in perfecting documentation.
This note took 31 minutes, 46 seconds to write in draft form and an additional 4 minutes, 55 seconds to type a final version and send to my editor at CardiologyNews. In case anyone were to ask.