Between Patients: The Myth of Multitasking

Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients”.

This involves doing a little bit of all those things in the invisible space between each fifteen minute visit, provided we can complete those visits, their documentation and any other work generated in those visits, in less than he fifteen minutes they were slotted for.

If we can’t capture (steal, really) enough time from our scheduled visits, we are still expected to somehow get that work done, but then on our own time. This results in most primary care doctors logging in to their EMRs from home after supper and on the weekends. Mismatched workloads and work schedule are a major source of professional burnout.

Compare this with air safety. Are airplanes scheduled to be in the air all the time, with refueling and maintenance squeezed in only if they happen to land ahead of schedule?

Quickly reviewing a couple of messages, a few lab results and some imaging reports, and then rushing in to see the next patient is an extremely inefficient and sometimes unsafe way of working.

I have likened this to jumping back and forth between baking a cake, balancing your checkbook and mowing the lawn. Normal people don’t work that way. Why do we expect doctors to?

Neuroscience teaches us that there is no such thing as multitasking. We really only do one thing at a time, and every time we switch from one task to another, we expend mental energy and brain glucose. Switching rapidly between tasks reportedly reduces usable IQ by ten points. Maybe doctors in general have IQ points to spare, but why organize our work that way on purpose?

MIT neuroscientist Earl Miller points out that juggling multiple plates floods the brain with cortisol (the stress hormone) and adrenalin (the fight or flight hormone), which prevents clear thought.

And those are the chemicals involved in burnout. In moderate doses, they are known to boost performance, but constant, low levels of them are the biochemical basis for burnout. We all know that.

My ideal way to work would be “protected” time for Results Review and Care Planning, and then, while another doctor does that, give me two medical assistants and double my number of exam rooms for efficient visits where I have already studied the charts and know better what I’m supposed to accomplish.

And, let me do slow visits grouped together, like physicals and wellness visits, and quick visits together, like sore throats, earches, rashes and knee pains. Slow and fast visits require different mindsets and skill sets. Again, comparing with everybody’s personal life, playing ping-pong or whack-a-mole interspersed with practicing or teaching yoga is very unintuitive an inefficient, at least as far as the yoga part goes.

Kind of like scheduled refueling and maintenance for aircraft…

4 Responses to “Between Patients: The Myth of Multitasking”

  1. 1 Ralph Allen December 3, 2017 at 1:53 pm

    makes good sense. perhaps the insurance world should notice.

  2. 2 sam December 3, 2017 at 5:44 pm

    It wouldn’t be airplanes in the sky all the time, it would be pilots working other tasks between flights. Different?

    I noticed on a recent visit to eye doctor for my daughter that the doctor had an assistant typing all the notes as she dictated during the exam. Probably smoothed the work flow a lot. Need to get yourself some interns or med students to ease the burden.

    • 3 CC December 4, 2017 at 2:31 am

      The majority of heavily medically-based eye care professionals do already have this in place. It has become a necessity rather than a privilege. Even with scribes, doctors are stretched far too thin. Why not just schedule more time? Well, then the problem becomes not enough availability and accessibility for the patients. The most challenging thing about this is the governmental controls that are requiring more and more ‘paperwork,’ and calling it in the name of quality of care. It is a real problem.

  3. 4 Renae December 3, 2017 at 10:58 pm

    The mental health field is similarly disrespectful (in my opinion) to therapists. We’re mandated to complete documentation, but not paid to do so!

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