title: Measuring up: musings of a family doctor on the employee time clock.
abstract: Recently, at the health maintenance organization (HMO) where I work, they introduced an employee time clock. As in many other workplaces, doctors across the country are now obligated to punch the clock at the beginning and end of their workday. This is the final act in an ongoing attempt to enhance management of doctors' schedules: limit nonurgent appointments to 10 minutes, define planned or urgent home visits, and control a physician's time, as well as managerial and clinical decisions. In this story I describe a day in the life of a family doctor, a salaried employee at a large HMO where there is now a time clock. I provide details on how the introduction of the clock influences small everyday clinical decisions that potentially affect the quality and depth of treatment while sharing the internal dialogue that accompanies me as I reaffirm my professional integrity again and again with each hastened visit. I also bring the internal dialogue of 2 of my patients, to illustrate the emotional world on the other side of these 10-minute interventions.
authors.affiliation: Department of Family Medicine, Hadassah School of Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kannai
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010561:Personnel Staffing and Scheduling; D010817:Physician-Patient Relations; D013997:Time Factors
keywords: chronic care; community; disease management/care management; management of health care; office management; organization and administration; public health