Opinion | Making the Most of the 24-Hour Day

There are only 24 hours in each day — no matter what we try and tell ourselves, no matter how hard we try.

The jobs we’ve taken on, the life we’ve chosen to lead, taking care of patients on the front lines of healthcare, has always, and will always, take a lot of time. The demands never really end. Can any of us honestly say there’s been a time or place during our job where we felt like, “There, we’re all caught up — there’s nothing more I could do; I’ve done all I can”? Still, no matter how we try, there really is no more time to be had.

Maybe part of the answer is to find a better way to use our time, to share the load, to spread the things around that need to be done to get our patients as healthy as they can be. This past week, I took some time off and went up to Cape Cod, to spend a few days at the beach relaxing with my family (see attached photo of me relaxing). We lucked out with incredibly beautiful weather, and we enjoyed a lot of the wonderful amenities that the small towns on Cape Cod have to offer: good seafood, cute little shops, and beautiful sandy beaches. There was only one small fly in the ointment — one member of our party downloaded the “Sharktivity” app on their phone, which detailed how many sightings of sharks were made that day off the beach where we were staying, so most of us never went into the water past our ankles.

This off time was necessary. The past few weeks, months, and years have led to enormous levels of burnout and frustration among healthcare providers, and we have all been feeling the strain in one way or another. Many, in fact, have chosen to cut back on their clinical duties, change to different jobs, or leave healthcare entirely.

While we were up in Massachusetts, I got an alert about an article in the Journal of General Internal Medicine, which once again analyzed how many hours it takes to take care of people in primary care. The authors did an analysis of a typical panel of patients, with the typical panel’s array of acute and chronic medical conditions, and factored in the amount of time necessary to manage these myriad diseases, make and treat acute diagnoses, coordinate care, and take care of all the patients’ counseling and healthcare maintenance needs.

Not surprisingly, the total in this theoretical model came out to greater than 24 hours in a day: 26.7 hours per day, to be precise. And this analysis is even a “best guess, assuming everything goes smoothly,” with no surprises or monkey wrenches thrown into the day, or into any one patient encounter.

A secondary analysis done in the paper showed that this time was significantly reduced with delegating many of the less “medical” tasks to other members in a more team-based system (such as with physician assistants, nutritionists, and nurses chipping in), but it still came in at well over the length of a “normal” workday for anyone else.

And this doesn’t count anything else we want to do or need to do in our lives, like taking a bathroom break, getting some water to stay hydrated, eating lunch, talking to our colleagues, or breathing in and out between office visits — let alone developing a research project, serving on committees, keeping up with the medical literature, going to conferences, or working to transform healthcare. And don’t even think about getting out of work at a decent hour, going home to quality time with your family, having a hobby, getting some exercise, getting the same amount of sleep that we recommend our patients get, seeing your friends, or going to a movie or reading a book just for pleasure.

There will always be more work we can do. Over and over again we’ve made suggestions about how to spread this work around, get the right people to do the right jobs, make sure that everyone is practicing up to their license, and enlist a broad array of members of the healthcare team to ensure that our patients get access to all the care they need — and that there’s plenty of time left over for truly shared decision-making and informed consent, and of course for documenting in the electronic health record.

As the authors of this study discuss, it’s quite clear that a straight fee-for-service model of healthcare will never be able to financially support or justify this kind of teamwork. But if we can build a better healthcare system, one that has all the resources our patients need, and we can eliminate the bureaucratic and regulatory stuff on the other end — the prior authorizations, the hours spent on the phone dealing with insurance companies, the faxing of forms back and forth — then maybe we can get back to loving our lives in healthcare, our patients will get better care, and maybe levels of inequity and unequal access will start to melt away.

And maybe, just maybe, we’ll have time to get home for dinner with our families.