Taking a step back – Dr Anel Reyneke shares her self-care audit

29 April 2019

When choosing an audit of medical practice topic, Dr Anel Reyneke knew it had to be something valuable. She identified her own self-care as a weak point and resolved to make improvements.

The Tauranga GP says she feels there is a growing expectation for GPs to give more and more, and that these expectations contribute to patterns of self-neglect.

“It was time to stand back and reflect on the way I was working and identify any areas I could improve to prevent burn-out.”

Anel decided to conduct an 11-day audit of her daily activities, which included an analysis of her work habits, break times, patient consults, and administrative tasks.

Generously, Anel has shared this audit so that her colleagues might benefit from her reflections – and perhaps be inspired to conduct their own reflective audits. See the full discussion below.

Originally from South Africa, Anel says she loves living in New Zealand and that the environment here contributes to her own self-care.

“I love the Kiwi lifestyle and I really can’t imagine being anywhere else now. I enjoy being outside and going for walks, so New Zealand is perfect for me.”

In 2003, she moved to New Zealand and completed the College’s General Practice Education Programme (GPEP).

“Being a GP is very fulfilling and the rewards come with time. When you’ve walked with someone through health and sickness, you become a part of their family story.”

An audit of medical practice is a critical analysis of your own practice, used to improve clinical care or health outcomes. You can apply to have an audit approved for CPD credit. Our CPD team has developed resources that explain different types of medical practice audits. Visit your Dashboard to find out more about conducting your own audit, and to see examples or tools.

Self-care audit by Dr Anel Reyneke

Driving home after yet another long day at work, I reflect on the stressors and strains in general practice.

There is an ever-growing amount of paperwork, pressure to achieve clinical excellence while also aiming for shorter and more focused patient contact time, not to mention non-contact appointments which pose a whole new subset of challenges.

I developed an audit to look at my own daily activities, which was the first step towards my “clinician wellbeing” programme. I investigated my work habits, break times and other activities, collecting quantitative data related to how much time I spent per activity. The aim is to work towards minimising or avoiding wasted time on certain activities.

An application for this self-care audit was endorsed by the College as a CPD activity, and I drew up a simple diary and entered each activity as I went through my day. I was aware that even the data entry for this audit could be considered an unnecessary ‘time-wasting’ activity (see appendix)!

Data was collected for 11 consecutive days in general practice. As I remain responsible for my inbox on the one day that I am not in practice, the time spent clearing the inbox from home was added to the data.

Breakdown of patients seen:

I expect to see 13 patients per half day. On audited days, all appointments were full, with some double appointments (including insertion of Mirena, minor surgery, or new patient consults).

When developing this audit, I anticipated that qualities of my patient cohort (for example age, multimorbidity, or complexity) would contribute to long workdays.

However, the data confirms that the much longer working days are not due to longer consultation times, but due to extended time doing paperwork. Thus the question: what activities under ‘admin time’ are so time-consuming?

Breakdown of admin time:

Notes on admin time:

1. Phone calls: not directly related to longer days.
2. Collegial contact: it is important to support and help each other in general practice. I debated this section as part of ‘admin time’, as it should ideally be classed as consultation/patient contact time. However, a 15-minute appointment schedule clearly does not allow for this. My opinion is that much more time can be spent on collegial support time, and that the work pressure undermines this important element of general practice teamwork.
3. Notes: my habit was to make shorthand notes in consultation, and then to elaborate on these during break times. Most days this added considerable time to my working days. I should be able to include this within the 15-minute appointment time.
4. Inbox: the inbox burden was very variable, which can be due to delays in receiving results, or days when a colleague’s inbox needs to be checked (when they are on holiday). The complexity of results, with the time needed to address the result, added to time spent on inbox.
5. Email/messages: finer breakdown of all other diverse tasks fell into this category. This equates best to the allocated ‘paid’ time for admin.
6. Insurance medicals: in the audit, this did not add significantly to the admin burden.

Just doing the audit made me more aware of how I spent my time, and highlighted the need to be more kind to myself.

Consultations should continue to be thorough, not rushed, but I also aim to complete consult notes within the 15 minutes. My consultations have changed since the audit – now I am not lenient if patients have long lists or add things at the end of the consult. It is a learning curve for both me and the patients, but has led to improved time-efficiency.

I haven’t yet found a solution for addressing the gap between the amount of time it takes to complete various tasks, compared with the amount of time I’m paid to do them. This will potentially continue to go towards the goodwill of the patient!

Having shared the audit with my peer group, I found the issues I faced seemed to be uniform. I hope that sharing this audit with my colleagues will result in more GPs reflecting on their own practice, and becoming kinder to themselves through the process.

Appendix: Daily activity sheet (example)