Physician activities during time out of the examination room.
OBJECTIVE
Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician office-based activities outside of the examination room.


METHODS
In the summer of 2000, 6 medical students directly observed and recorded the office-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day.


RESULTS
The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records.


CONCLUSIONS
If office-based, medically related activities were averaged over the number of patients seen in the office that day, the average office visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care.
Gilchrist
Valerie
V
Northeastern Ohio Universities College of Medicine, Rootstown, USA. gilchristv@mail.ecu.edu
McCord
Gary
G
Schrop
Susan Labuda
SL
King
Bridget D
BD
McCormick
Kenelm F
KF
Oprandi
Allison M
AM
Selius
Brian A
BA
Cowher
Michael
M
Maheshwary
Rishi
R
Patel
Falguni
F
Shah
Ami
A
Tsai
Bonny
B
Zaharna
Mia
M
D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D005791:Patient Care; D011216:Practice Management, Medical; D013647:Task Performance and Analysis; D013996:Time and Motion Studies