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The Unfortunate Loss of Patient Contact During Residency

2016; Lippincott Williams & Wilkins; Volume: 91; Issue: 9 Linguagem: Inglês

10.1097/acm.0000000000001308

1938-808X

Thomas Corbridge,

Electronic Health Records Systems

To the Editor: I was disheartened by Mamykina and colleagues’1 recent study that showed residents at a leading medical center spent less than 10% of a day shift interacting with patients, and over 50% interacting with computers. This anti-Oslerian misappropriation of time and talent represents another attack on a profession already under siege. Increasingly, physicians are required to deal with massive student loans, inadequate time with patients, high caseloads, assembly-line patient throughput, inordinate documentation requirements, electronic medical records, billing, malpractice, stress, burnout, long work hours, and work–life imbalance. Day-to-day realities of medical practice are eroding the very essence of what it means to be a physician, and the profession is struggling to keep its identity. Most physicians know something is terribly wrong, and some just want out. Others discourage bright and caring students from becoming physicians, which is indisputable evidence of a distressed profession. Case in point: A retired and respected dean of a medical school heard that my son was starting medical school this summer and asked, “Why in God’s name would he ever do that?” I admit that I have had similar thoughts. But I do not want to be someone who clobbers the dreams of my son or any other student from pursuing their passion and embarking on what I believe can still be a magnificent journey. I am not alone. Many physicians remain positive—not “Pollyannas,” but aspirational role models. How do we move forward? For me, it starts by remembering what it means to be a physician. Being a physician is an unsurpassed privilege. We join the lives of patients and families during vulnerable and intimate moments and have the knowledge, skills, and compassion to help them heal. We study the magnificence of the human body. We learn. We discover. We teach. At the heart of it all is the physician–patient relationship. This requires time, which is why the findings from Mamykina and colleagues are so concerning. We need to do all we can to return to the bedside. In our hospital, many of us have changed our rounding structure from discussions taking place mainly in the hallway outside patients’ rooms, to rounds conducted almost entirely at the bedside. This approach has increased time with patients and families without adding to the total time. I think this small but meaningful change also improves the accuracy of the medical history; allows for more thoughtful discussions of exam findings, pathophysiology, and therapeutics; and helps build relationships. I’ll close with some thoughts for my son as he prepares to enter medical school: Learn what it truly means to be a physician, spend as much time as you can with your patients, work with your colleagues to tackle the problems facing the profession, shoot high, be efficient, and seek work–life balance. You are in for an incredibly rewarding ride. Thomas Corbridge, MDProfessor of medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; [email protected]