2009 Volume 21 Issue 1 Pages 39-54
Backgrounds : Several recent studies have focused on Japanese doctors’ working time and their workload. All these studies are, however, questionnaire surveys, and direct observations have not been attempted since 1996.
Purpose : To investigate doctors’ working time by direct observations and to compare the results with those of self-recorded diary surveys.
Methods : We conducted a time study on 16 doctors covering five consecutive days and from 9 am to 4 pm each day by direct observations. The subjects are all male general surgeons between the ages 31 and 59, with an average age of 44.6, who work in 3 teaching hospitals. We also conducted parallel self-recorded diary surveys on 10 doctors（all male general surgeons, 31–56 years old, average age 42.1）in 2 of these 3 hospitals. We then compared the self-recorded working time data with the working time data obtained by direct observations.
Results : Out of a total of 20,049 minutes of recordings in this study, those by direct observation accounted for 13,931 minutes （69.5%）. Doctors spent 82 percent of their time in clinical practices: they spent 55.6% of their time in out-patient care, 16.7% at the nurses’ station, and 9.7% at patients’ bedsides. Time spent in the presence of patients accounted for 64.3% of the time for out-patient care and 38.8% of the time for in-patient care （i.e., at patients’ bedsides and at nurses’ stations）. A total of 9.9 minutes per patient were spent for out-patient care, of which 6.3 minutes were spent in the presence of patients and 3.5 minutes were spent in their absence. For inpatient care, a total of 4.6 minutes per patient were spent per patient, of which 1.7 minutes were with the patients and 2.9 minutes were in their absence. Doctors performed the following tasks when patients were present; medical interviews（77.7% of out-patients and 72.6% of in-patients）, explanation of the diseases （94.4% of the out-patients and 56.8% of the in-patients）, physical examinations（64.7% of the out-patients and 41.1% of the in-patients）, treatment of wounds（6.1% of the out-patients and 16.8% of the in-patients）, confirmation of medical records and laboratory test data（72.4% of the out-patients and 3.4% of the in-patients）, computer operation（61.0% of the out-patients and none of the in-patients）, simple paper works（25.3% of the out-patients and 0.3% of the in-patients）, and chart recordings （57.9% of the out-patients and 0.3% of the in-patients）.
The ratio of the self-recorded working time to the actual working time obtained by direct observation were 0.98 for out-patient care（95% CI; 0.91–1.06）, and 0.94 for inpatient care（95% CI; 0.76–1.13）.
Conclusions : Using a direct observation method, we were able to measure the time spent with the patients and time spent without patients, and record the various tasks doctors have performed. Round-the-clock direct observations proved to be difficult, requiring increased cooperation from physicians, more recorders, and more money. Our result indicate that doctors’ self-recorded diary surveys are practical substitute for direct observations on their time spent for out-patient care and inpatient care, as the differences between the self-recorded diary observations and the direct observations were minimal.
