Abstrait

Managing time-constrained doctor-patient encounters: A proposal for a teaching program by a former doctor and present patient.

Benbassat J*

Medical training emphasizes a thorough history, system review, head to toe examination and a detailed problem-oriented record. The author is not aware of attempts to teach how to practice when time constraints preclude such a comprehensive ?patient work-up". In the absence of formal teaching, medical graduates devise their own shortcuts that may be dysfunctional. The objectives of this paper are to (a) draw attention to four such shortcuts and (b) suggest a set of priorities in data gathering when time constraints do not permit a detailed "patient work-up". The author proposes that students should be taught to (a) Postpone viewing the electronic medical record to the end of the encounter, rather than focus on the screen immediately after greeting the patient. (b) Listening to the patient's narrative for 2-3 minutes, rather than interrupting it within seconds. (c) If needed, perform a focused, rather than a head-to-toe physical examination, and (d) Conclude the encounter by updating the electronic record while sitting at the patient's side, rather than at the other side of the desk, in order to ascertain the patient's understanding of, and agreement with the doctor's findings, assessment and plan for management.