Annals of Family Medicine -- Comments for Gottschalk and Flocke, 3 (6) 488-493

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Original Research:
Andrew Gottschalk and Susan A. Flocke
Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room
Ann Fam Med 2005; 3: 488-493 [Abstract] [Full text] [PDF]

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Electronic letters published:

administration, the ruin of medicine: Charles Lapp (13 January 2006)

Bravo on addressing an important issue: John W Beasley (18 December 2005)

administration, the ruin of medicine 13 January 2006

Charles Lapp,
Sterling Hts. MI usa
MD old gp
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Re: administration, the ruin of medicine

Ultimately the working man pays for all "benefits" out of his wages. There was a 3$ cash OV when I started, now the Ov is 100$ with paperwork++ each layer of administration costs 30%. Jobs are going elsewhere and care is becoming less available. More time and money goes to administration. All business should follow the K.I.S.S. principle keep it simple stupid.
Competing interests: None declared

Bravo on addressing an important issue 18 December 2005

John W Beasley,
Madison, WI
Professor Emeritus, UW Department of Family Medicine
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Re: Bravo on addressing an important issue

I applaud Gottschalk and Flocke for continuing to "open the black box" of primary care. This helps us both to recognize the realities of our work -- and to force us to be more accurate (and perhaps less self- serving) in our statements about our work such as the fact that we spend about 13 rather than about 19 minutes in face to face contact.
Like all good research, more questions are raised by the work which has been done. For example, further analysis of how the realtionship of the time spent in and outside the room varies with respect to the number and complexity of the patient's problems would be of interest. The number of minutes per problem would be one potential measure.
Another question would be the relationship of the various measure to different uses of technology. For example, a study of the impact of EMR's on the time spent inside and outside the examination room is critically needed. The current evidence is that while physicians using EMR's feel that the quality of their medical records is better, that there are no other differences in time pressure and perhaps a slight negative impact on quality of professional work life. (1)
Finally, it would be very useful to have some experimental exploration of strategies to make the work more efficient such as dictating in the presence of the patient.(2)
1. Karsh BT, Beasley JW, Hagenauer ME. Are electronic medical records associated with improved perceptions of the quality of medical records, working conditions, or quality of working life? Behaviour & Information Technology 2004;23: 327-335.
2. Sutherland JE, Egbert N, Gjerde CL, Pint-Burke T, Franklin C, Walker D. Arch Fam Med 1998;7:281-284
Competing interests: None declared