As I suspect is true for most professionals, the slog of paperwork, computer work, phone calls, and charting is what can really lead to fatigue for physicians. The actual care of patients is only one part of the work we do. Documentation often bleeds into lunch hours, evenings and nights at home, early mornings, and weekends. Here is a list of ways to approach the never-ending and ever-increasing volume of documentation we each face. Pick a couple at a time.
If you are able, hire a scribe. My scribe is an absolute God-send. Do the math on the number of patients you are able to reasonably currently see, the average salary for a good scribe, and the amount of patients you'd be able to comfortably increase to with their help. A good scribe pays for herself with increased efficiency and volume of patients.
Between seeing patients, try to do one note or one task. For each one patient, do one small task. If you don't have the time to complete the immediately preceding patient's notes and orders, then do one thing on the patient before that. Oftentimes when we start to get behind on our schedule, we fall into all or nothing thinking. We think "I'm already behind, I'm just going to focus on seeing the patients and do all the documentation later." That can feel like relief in the moment, but this will undoubtedly lead to a much larger mountain of procrastination later. One patient, one small task.
Go for the low-lying fruit first. As you scan your Inbox, email list, or list of patient notes to write/edit/review, go for the easiest stuff first. The really quick sign-offs, the quick image reviews, the stable patient note that needs a fax to the outside provider. Start to quickly check off the easy stuff. Momentum is better than motivation. Once you see a few tasks fall of the list, you will be into the groove to keep going.
Do B-minus work. Don't go for perfect. Get things done well and efficiently. If you are trying to do a perfect note each time, you are more likely to procrastinate doing it and more likely to forget something. Get the most important elements in the note, and move on.
Remember the purpose of documentation. The purpose of a physician note is:
For you to remember the next time you see the patient what the diagnosis and treatment was
To communicate to other healthcare providers your thoughts, diagnosis, and management recommendations
To get paid by the insurance company
To give the evidence (history, exam, labs, imaging findings), decision-making, diagnosis, specific treatment recommendations, and risks and benefits, so that if a lawsuit occurs, there is a complete picture
With all this in mind, don't overdo it. You don't have to write complete paragraphs. Its ok to have subpar grammar, punctuation, or spelling here and there. Keep the goals in mind, the big picture at the forefront, and get it done.
When you have a large or dreaded project, ask yourself what the smallest possible next step is. Then just do that. Move on to other things. Take turtle steps.
Think or say out loud "Easy button!!" with great gusto whenever you do a task. You laugh. It works.
What if I had to? I often put myself in a trap of wanting all of my conditions perfect before I get started. Nice lighting, the best pen and notebook, a computer with a large screen, my emotional support chapsticks and hand sanitizers at the ready. But sometimes the task just needs to be done. I think "what if I had to do this right now? What if my plane was leaving, and I had to get these orders in before I was whisked away to the North Pole for 3 weeks?" Then suddenly the perfect pen and notebook aren't needed - you just get that shit done.
Set an artificial time constraint. Look at the clock and say "I must be out of here at 5:30." Constraint gives clarity. Suddenly you're not looking for the perfect word to say, you are getting the most important things on the page and moving on.
Enjoy it. Make it a game. Feel pleasure with the way your fingers hit the keys when you're in the flow of typing, enjoy writing and checking things off your list. Put some music on. Get a hot drink and light a candle. Take a minute to fully appreciate that you are no longer in the weeds of trying to figure out how to examine patients or how to make diagnoses, but in the phase of mastering efficient documentation. Keep it light, easy, enjoyable, and fun.
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