PURPOSE Comprehensive medical care requires direct physician-patient contact, other offi ce-based medical activities, and medical care outside of the offi ce. This study was a systematic investigation of family physician offi ce-based activities outside of the examination room. METHODSIn the summer of 2000, 6 medical students directly observed and recorded the offi ce-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTSThe average offi ce day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Offi ce-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the offi ce practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records.CONCLUSIONS If offi ce-based, medically related activities were averaged over the number of patients seen in the offi ce that day, the average offi ce visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care.

The final ACP-SE scale included 17 items and demonstrated high internal consistency.

Most family physicians and pediatricians support the use of corporal punishment in spite of evidence that it is neither effective nor necessary, and can be harmful. Pediatricians offer anticipatory guidance on discipline more often than family physicians.