William Cayley: Can we beat the productivity paradox by working smarter, not harder?

bill_cayley_2During my morning drive recently, a radio story on the “productivity paradox” caught my attention. Briefly put, the story explored economists’ concerns that despite ongoing technological development, our actual work productivity (ie. value produced per hour worked) on a global scale has stagnated. We seem to be coming up with fancier and more developed ways to do things, but not actually getting more things done.

Frankly, as I mulled over my day to day work as a doctor, I found this unsurprising for several reasons, all of which imply potential solutions.

It is commonplace to hear complaints about the use of electronic medical records (EMRs): that they make documentation more tedious or time consuming, that they distract from the patient’s visit, that they turn medical care into a series of “clicks.” While all of these complaints make valid points, it also seems true that many who register such concerns seem to still use EMRs in the same way they used old paper charts. We need to realize—and make genuine use of the fact—that EMRs are not a collection of electronic documents and charts; rather, a well built EMR is a true interactive database that may require careful entry of information, but which can also be exploited for efficiencies in information management. We need to be smarter about how we use our electronic documentation, rather than working harder to make it do what our old record systems used to do.

At the same time, we need to also think carefully about when it is or is not appropriate to use our newer technologies. Text messaging has become the modus operandi for much medical communication. While this conveys certain advantages (including allowing asynchronous communication, and a certain level of privacy in secure systems), it’s also important to remember that sometimes a simple phone call is better than a series of back and forth messages. It’s one thing to text to a partner “hey, your patient is in room 201.” It’s entirely different (and much more tedious) to tap out a prolonged discussion of a complex case by text message—sometimes a phone call really is better. Smart use of communication can be much more productive than working harder at using our latest communication toys.

Finally, I’ve written before about my thoughts on using evidence to point us to areas of medicine where simpler is better. As our understanding of patient centered use of evidence continues to evolve, we need to be ever on the lookout for those areas of medical practice in which evidence suggests a less medical, less technological, or less costly approach may actually provide better outcomes. Smart use of evidence may—in some areas of medicine—actually simplify what we do.

A few tweaks to how we approach our medical practice will probably not overcome the global productivity paradox (just a bit of understatement here!), but conscious efforts to shift our energy from working harder to being smarter about how we work may at least help move us in the right direction.

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare—the “less is more” project I created is a free, noncommercial, educational resource.