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A systematic review of evidence on the links between patient experience and clinical safety and effectiveness
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    Increased U.S. primary care consultation duration due to EHR burden?
    • Rani Marx, Epidemiologist/Health Services Researcher Initiative for Slow Medicine
    • Other Contributors:
      • James G. Kahn, Professor

    We read with great interest the comprehensive review of primary care consultation duration in 67 countries between 1946 and 2016 by Irving et al (1). This review is especially timely given rising physician burnout, as well as dissatisfaction among both doctors and patients in the U.S. As the authors note, many physicians are frustrated by the limited time available to interact with patients.

    The increasing time of U.S. physicians with patients surprised us. Primary care physicians in the U.S. rank fifth out of ten high-income countries on dissatisfaction with time spent per patient (2). What explains this apparent mismatch of quantitative trends and satisfaction?

    One candidate explanation is that much of physician time is spent on activities other than communication with patients. According to an observational study in 2015 of 57 ambulatory care physicians (primary care, cardiology, and orthopedics) in 16 practices in 4 states, of time spent with patients in the exam room, 53% was spent face-to-face, 37% on the electronic health record (EHR) and desk work, and 9% on administrative tasks (3).

    Thus, we wondered if the U.S. trend in primary care consultation duration reported by Irving et al aligned with historical trends in EHR uptake. In the Figure (http://blogs.bmj.com/bmjopen/files/2018/05/Figure-US-Primary-Care-Consul.....

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    Conflict of Interest:
    None declared.