At one point, Carmen came into my mother’s room to do patient education with a wizened old lady in the next bed. The woman was about to be discharged after a bout of heart failure and Carmen did a terrific job. In about a minute flat, she hit the high points of salt restriction, daily weights, and medication adherence. She then apologized to the patient because there was a code down the hall and her services were urgently needed.
Some time during the course of the shift when the ward settled down, Carmen would no doubt go to the nursing station and spend many minutes or hours documenting what she had done that day. I am positive that the documenting took more time than the doctoring or—in this case—the nursing.
If there is a finite amount of time that can be spent on each patient, what would be the best allocation: documenting care or providing it?
Documenter’s Dilemma
We are living in a time when there are critical shortages in the provision of medical services and a failure to attract and adequately compensate healthcare providers— especially nurses—who do heroic work under very trying circumstances. If there is a finite amount of time that can be spent on each patient, what would be the best allocation: documenting care or providing it?
Fortunately, Carmen’s patient picked up on the essentials on heart failure. Given Carmen’s furious schedule, I wonder what would have happened if the patient had questions about what kind of scale to use or how much salt is in a bag of potato chips. Seeing how Carmen worked, I suspect that she would have returned after the code to explain again and then stayed late to document while her family ate their dinner without her.
In my own practice, I am spending more and more time documenting and less and less time doctoring. The need for rheumatology services grows. There are not enough of us to care for patients or to teach. An increasing amount of time is consumed with writing about what we do and a decreasing amount of time is devoted to doing it. In this onslaught of documentation, I would include obtaining permission from payers to prescribe certain treatments.
During my house staff training, one of my co-interns relayed his experiences on a rotation in the African bush. The time was well before AIDS but malaria and tuberculosus were rampant as were the other parasitic diseases that caused incredible devastation. Suffice it to say, sub-Saharan African did not—and does not—have a lot of money to spend on healthcare, and they could not use precious dollars on medical records.
