It is no secret that the computer-facing aspects of medical practice are time consuming. A 2016 study published in the Annals of Internal Medicine found that physicians in ambulatory care settings may spend up to “two additional hours…on electronic health record (EHR) and desk work” for every hour spent face-to-face with patients (1). This “desk work”—from documentation of treatment plans to completion of legal forms necessary for billing and patient services—can place significant time and resource burden on providers (2). In fact, in a recent survey conducted by Medical Economics, “paperwork and administrative [tasks]” ranked first on the “list of issues ruining medicine for physicians” (3). Given how commonly physicians endorse time pressure at baseline as they seek to address patient concerns and engage in therapeutic conversation all while respecting clinic or unit schedules, any additional tasks—especially if not perceived as clinically useful—may increase "stress, burnout, and [even] intent to leave" medical practice (4).

Yet "desk work" is not all bad. Recording clinical thought processes, organizing treatment plans and ensuring adherence to various guidelines and safety checklists can “[make] us better physicians and…[force] us to think more clearly and methodically,” asserts one family medicine doctor (5). Physicians may even find the time spent writing notes valuable insofar as it facilitates research, continued medical education and thoughtful diagnostic reasoning—all beneficial to patient care. Moreover, in the age of increased specialization, multiple providers and interdisciplinary care, documentation can help to “centralize” information, enhance communication, pool intelligence, and even prevent medical error (2,6,7). Herein lies a potential conundrum for clinicians: with limited time, how does one balance the pros and cons of screen/desk time with face time, the historical rationale of medical practice?

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Illustrative scenario:

A hospitalist is taking care of twenty patients on a medical floor. She calculates that spending just fifteen minutes with each patient/family at the bedside will take five hours of her nine hour day. She also has to participate in interdisciplinary rounds for all patients, write numerous notes, think about plans, conduct appropriate research where needed, and give medical students a lecture—all in the same day.