My colleagues are having this perennial discussion of how to fix our broken system, and one notion that comes up is to see more people in less time, i.e. to move faster. I notice that it’s often males who favour speed, and females who favour depth of assessment.
Regardless, we have a problem in our emergency department, as do most emergency departments in Canada – waiting times. This is the same problem as the wait to see any other specialist, only here we are talking about minutes or hours, as opposed to weeks to months. But it’s still the same problem.
The ideal of medicine is one patient at a time, in depth and with patience. When we are taught how to examine a patient, or how to interview them, we are taught “get good, then get fast.” So it may take a medical student an hour and a half to do a patient assessment. A resident or junior doctor may take an hour. A senior doctor may take a half an hour.
…or in the world of the emergency department, these times may be shrunk to five minutes. Currently, a clinic where I work has proposed that doctors should see six to eight patients an hour. That’s eight to ten minutes per patient. I know a few doctors who are comfortable working at that speed, but many more who would not choose to go that fast.
The emergency department where I work has proposed a rate of two to three patients per hour, or twenty to thirty minutes per patient. This includes intital assessment, ordering and reviewing tests, speaking to consultants, providing treatments, and planning for discharge or admission to hospital.
A friend I know who works as a family doctor says that it’s possible to make a decent living (i.e. save for retirement and kids’ college education) as long as he sees forty patients a day – one patient every twelve minutes for eight hours straight.
My record for longest assessment was nine hours – starting with a patient being interviewed in my office, having a seizure, getting transported to the emergency department where I treated his seizure, to more tests, to discovering that he felt the seizures were from a curse, to his cousin bringing some holy water in from a church, and finally to discovering that holy water seemed to stop his seizures. There were many breaks during those nine hours, where I left him to rest and saw other patients. It was a very satisfying case, but there were probably a lot of other patients who had to wait longer meanwhile.