1. Time-pressed physicians spend significantly more time on computer than on direct patient interaction
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2238 URLs go live when the embargo lifts
Internal medicine physicians at a Swiss teaching hospital frequently worked overtime and spent about 3 times as much time using a computer as they did on patients. Most of their time at work was spent on activities indirectly related to patient care. Results of the time and motion study are published in Annals of Internal Medicine.
The structure of a resident's workday has changed dramatically in recent decades, with limitations on hours worked per week, wide implementation of electronic medical records (EMRs), and a growing volume of clinical data and administrative tasks. A recent study found that physicians use about 50 percent of their time using EMRs, but few time and motion studies have focused on how computer use affects resident's time allocation. This is important because less time spent with patients decreases physician satisfaction and patient education and health promotion and increases inappropriate prescribing and medical malpractice.
Researchers sought to objectively assess the type and duration of activities performed by internal medicine residents throughout the day. The primary focus was to estimate the time spent with patients and using a computer. The secondary focus was to identify individual factors influencing residents' allocation of time to different activities and contexts.
Trained observers used a tablet-based application to record and categorize 22 job-related activities for 36 internal medicine residents. They found that most residents worked an average of 1.6 hours longer than the official 10 hours scheduled. After-hours activities consisted mostly of writing in the EMR. Overall, for every hour the residents spent with patients, they spent an average of five hours on other tasks. Activities indirectly related to patients predominated and about half the workday was spent on the computer. The authors suggest that organizational changes and EMR improvements are required to increase efficiency.
Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Nathalie Wenger of Lausanne University Hospital, can be contacted for interviews directly at Nathalie.Wenger@chuv.ch.
2. Young men exposed to violence at risk for carrying guns
Prevention and intervention strategies should focus on those likely to experience psychological distress related to violence
Abstract: http://annals.org/aim/article/doi/10.7326/M16-1648 URLS go live when the embargo lifts
Young men involved in the criminal justice system may be influenced to carry a gun based on their exposure to violence either perpetrated against them or witnessed by them. The findings are published in Annals of Internal Medicine.
Gun carrying among youths is a significant public health concern in the United States. While weapon carrying and exposure to violence have been repeatedly been linked in studies of minority, inner-city youths, few studies have assessed the potential effect of exposure to violence on the associations between gun carrying and psychological distress among vulnerable adolescents.
Researchers surveyed 1,170 young men aged 14 to 19 years who had been found guilty of a serious criminal offense in Philadelphia, PA and Phoenix, AZ. The youths were assessed at baseline and at four- and six-month intervals between 2000 and 2003 with regard to gun carrying, psychological distress, and exposure to violence.
The authors expected that gun carrying would be linked to higher levels of psychological distress, that exposure to violence would predict carrying, and that the association between psychological distress and gun carrying would become less prominent when the effect of exposure to violence, as either a victim or a witness, was considered. The research confirmed that psychological distress and gun carrying was influenced by exposure to violence (either experiencing or witnessing it). The findings suggest that access to trauma-informed treatment to address repeated exposure to violence and its psychological aftermath may be a critical element in combating gun carrying and gun violence among high-risk, vulnerable adolescents.
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Note: For an embargoed PDF, please contact Cara Graeff. To reach the lead author, Joan Reid, PhD, of the University of South Florida, please contact Casey Crane at ckcrane@mail.usf.edu or 727-873-4840.
Journal
Annals of Internal Medicine