It’s been a long time since I blogged about the inanity of multitasking in a cognitively demanding environment, but my friend Mark Graban sent me an article that reminded me of how important this topic is. 

According to a new study by Penn Medicine and Johns Hopkins, first year physicians spend 87% of their time on indirect patient care, half of which is consumed by the various electronic medical record systems. Worse, they spend only about three hours per workday on direct patient care, and they multitask during a large chunk of that time. 

I’m not a physician (and I don’t play one on TV), but I’m pretty sure that spending 87% of your time away from the customerpatient can’t be any good. To be sure, there’s certainly value—doctors need to do research, examine lab results, evaluate patient and family history, etc.—but 87%? And I know there’s incidental work that must be done in order to ensure high quality care and compliance with the thicket of regulations that hospitals and physicians labor under. 

But still: 87%? It’s hard to imagine a scenario in which 87% is the appropriate amount of time to spend away from the patients to whom caregivers devote their lives. And I can’t think of a single doctor (including my wife) who has said, “Yeah, I spend way too much time with sick people. There’s nothing better than a few hours in the privacy of my office messing around with the EMR.”

The multitasking issue is perhaps even more alarming. The time that the physicians have in direct contact with patients is so limited, you’d think that they’d want to maximize its effectiveness. But by multitasking, they compromise the benefits of the face-to-face interaction. The research on multitasking is voluminous and unequivocal): it simply doesn't work. Whether you’re a student taking notes, a businessperson reading email while in a meeting, or a doctor listening to a patient, if you’re splitting your attention between two cognitively demanding activities, you’re not going to do either of them well. When you think about the importance of using all your senses to really engage with a patient to deeply understand the problem, well, multitasking is a recipe for misdiagnosis, medical errors, and at the most basic human level, just plain hurt feelings. (“Why isn’t the doctor looking at me and paying close attention?”) 

The fact that the physicians are coordinating care or updating medical records for about 25% of the time they spend with patients reminds me of a story that my friend, Roger Chen, former head of CI at Martin Memorial Health System told me. Years ago, MMHS invested heavily in computers on wheels (“COWS”) for the patient rooms to make it easier for the doctors to enter information while they were with their patients. Unfortunately for MMHS’s finances, it turned out that patients hated the COWS—they felt that the doctors weren’t really paying attention to them when they were multitasking (listening and typing). So they scrapped all of them. 

We spend a lot of time in the lean community talking about value added activity, incidental work, and waste. Many hospitals are beginning to turn that lens on physician activity. It seems like a good idea to bring that mindset to the training of new doctors as well.