Hospitalists should limit the number of patients they see

I was talking to a fellow physician and he inquired, “how many patients do you see in a day?” I said, “maybe around 20.”

He smirked and replied, “20 only! I can see around 40 in a day and still have time to hit some balls.” There is something fishy here at Smallville.

A few years ago I used to work for this company. I had no option but to see a huge number of patients. Sometimes my census would be around 40 or so. I remember one day that I got 26 new admissions. I took care of them all along with the patients who were already on my list. By the end of the day I was a tad confused. When nurses would call it would take me a moment to recall a patient. I would have to think twice so that I don’t confuse a chest painer with a GI bleeder.

You can see a lot of patients, but I think it is not fair to the patient. It is just not about billing. You cannot provide adequate care when you are breezing through your list. The goal is not just to see them but to make the right decisions. One way to see them would be to call 20 thousand consults and let other doctors make decisions for you, or you can try to see them like you should and spend your whole day and night seeing them all.

The devil is in the details. If you are detail oriented and if you have a good system in place, then you decrease your chance of error. Believe me, it is going to happen. You will make an error (Murphy’s Law), but the difference is the gravity of error.

So what is the magic number? Various factors play a role when you consider the right number of patients to see. If you have mid-level support or you have residents, than you can probably see more, but that is not the case for most of us. I think 15-20 patients per day is a fair number in a 12 hours shift in a hospital setting.

I read  this article sometime ago at Today’s Hospitalist, it nicely breaks down various situations versus patient census accordingly.

I call these doctors Super Doctors: “Look! It’s a bird. It’s a plane. No, it is a Super Doctor!” No patient can really identify what breezed through them. But just remember it takes only one piece of kryptonite to bring down the mighty.

S. Irfan Ali is a hospitalist who blogs at Human Factor in Medicine and Life.

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