Reclaiming time in family medicine

Clinical question

What can be done to reduce the number of unnecessary clinical tasks in family practice?

Bottom line

Physicians face numerous time-consuming demands, with administrative tasks often perceived as a burden. In contrast, clinical tasks are expected and necessary, although some may not be required. We seldom reflect on the many unnecessary clinical tasks that represent a hidden driver of physician workload (Figure 1). Unnecessary diagnostic testing may trigger subsequent follow-up visits or inquiries from patients, repeated investigations and diagnostic testing, or referrals, taking up valuable clinical time. This represents a lost opportunity by diverting time and attention away from high-value care that can improve patient outcomes.

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Figure 1.

Unnecessary clinical tasks

Evidence

According to the Canadian Institute for Health Information, up to 30% of diagnostic tests and medical treatments may be unnecessary¹ and unlikely to benefit patients, while also potentially being harmful. Over the past decade, Choosing Wisely Canada has provided guidance on how to avoid low-value care, but many low-value care practices still exist in family medicine.

Mitigating clinical uncertainty and managing patient expectations are often cited as reasons for ordering unnecessary diagnostic tests.² However, many patients appreciate discussing care options instead of undergoing unnecessary diagnostic testing. Brief, evidence-informed conversations can clarify the benefits and harms of diagnostic testing and medical treatments, while also strengthening patient trust in primary care. A simple tool, presented in Box 1,³ can guide conversations when patients request diagnostic tests that are not supported by the evidence.

Taking time during an appointment to explore a patient’s medical concern, or explain why a diagnostic test is not needed can reduce unnecessary tasks in the future, and improve patient satisfaction. Longitudinal relationships create trust to support watchful waiting when appropriate. These moments are not just efficient—they are part of what makes family medicine effective, relational, and sustainable.

Time as a finite resource. The concept of time needed to treat (TNT) refers to the time a clinician spends carrying out an intervention.⁴ Estimating TNT involves reflecting on the frequency of the intervention, time spent performing the intervention (eg, proceeding to an annual physical examination or time required to order a test), expected rate of abnormal diagnostic test results, and time spent managing test results.

The cumulative time diverted toward unnecessary diagnostic testing and associated tasks, such as explaining benign test results or tracking incidental findings, ultimately erodes capacity for meaningful patient care. Table 1 provides a measure of the TNT for 3 clinical scenarios and highlights the burden of unnecessary diagnostic testing on clinician time.^5,6 For patients, receiving a diagnosis based on a mildly abnormal finding can be distressing, alter how they perceive their health, and lead to unnecessary follow-up or treatment. When repeated across many patients, and over an extended period, especially in primary care settings that rely on continuity, the cumulative impact on provider time and overall systemic inefficiencies can be considerable.

Table 1 illustrates how overtesting may lead to unwise use of clinicians’ time. These decisions lead physicians to divert time and resources that could be allocated to patients with more pressing health needs, or for interventions where the benefits are demonstrated. While the amount of time devoted to low-value care practices may appear trivial, when estimated, time spent on unnecessary clinical tasks is substantial.⁷ Simply changing one’s practice to reduce unnecessary tasks represents weeks of physician time that can be reallocated.

If the assumptions used in these calculations seem unrealistic for your practice, or if you have other examples in mind, a recently developed tool, the Time Needed to Treat calculator,⁷ can help you calculate how much time you would be able to use wisely with your patients. While not intended for individual performance auditing, this tool may facilitate clinician reflection about the sustainability of practice and enable meaningful change.

This calculator does not include the time spent throughout the system. Low-value care consumes resources beyond physician time as nurses, administrative staff, technicians, and patients are drawn into unnecessary tasks. Financially, these tasks contribute to wasteful spending in already resource-strained systems. Environmentally, they create avoidable emissions through additional laboratory processing, energy use, and patient travel. Perhaps most critically, they impose opportunity costs: Time spent on low-value care is no longer available for situations where it could improve patient-oriented outcomes.

Using time wisely. Health care professionals often operate within a clinical, financial, and policy landscape that imposes systemic constraints. However, within these boundaries, physicians can still intentionally find ways to preserve their time and resources to foster a more sustainable practice culture.

We need to support a shift away from unproductive routines and stop ordering diagnostic tests unlikely to benefit patients. Time is essential to providing care and it must be carefully stewarded. By preserving valuable clinician time and focusing on what is essential, we can foster better, higher-quality, and safer patient care. Time is 1 of the most limited and valuable resources in primary care. Reducing low-value care, even in small ways, can restore capacity for meaningful, patient-centred care. This shift benefits both clinicians and patients.