Time use and physicians' exploration of the reason for the office visit.

BACKGROUND: Patient-centered clinical methods encourage physicians to explore the patient's reasons for the visit. Practitioners worry that this behavior may be inefficient. This study piloted a method to examine how the number of problems managed and time per problem vary with time spent exploring a patient's views.
METHODS: Exploration of a patient's views, medical investigation, explanation, and management were mapped against time for a defined agenda from videotapes of eight second-year residents seeing three simulated patients. Performance of three of four tasks defined completion of work on an agendum. Visit length, time per agendum completed, and proportion of agenda completed were compared with time per task using regression methods.
RESULTS: Time on exploration correlated with visit length and proportion of agenda completed, but other tasks did not. Time per agendum completed was unrelated to time on exploration.
CONCLUSIONS: Visits were longer when more time was spent exploring the patient's reason for the visit because the physician tackled more problems. Time required per problem was not significantly increased. Task/agenda mapping is worth further development to examine differences in comprehensiveness and efficiency among practice styles.