Let’s face it, what’s getting most physicians down is not their patients. No, ask any group of physicians what the hardest part of the job is, and you’ll like get a pretty consistent response: It’s the EMR! With studies showing that we spend, on average, two hours on “paperwork” for every hour in the room with a patient, there’s no question that it is a massive time suck for most. Yet, the EMR is definitely here to stay, so what can you do?
You may have met with IT, gotten smart sets, templates, and other hacks. You may have shadowed an uber-efficient colleague in your practice. You may have even been lucky enough to get a scribe.
Even with all these fixes, many physicians are still struggling to get the job done, spending hours upon hours at the computer, charting in the evenings, weekends – in what often seem like every waking hour. Charting saps precious time and energy that could be spent with family, on personal projects, or simply unwinding.
It’s one of the prime contributors to career dissatisfaction and burnout.
In the hundreds of physicians I’ve coached over the past decade, I’ve seen three consistent patterns that dramatically worsen charting inefficiency.
1. Expecting perfection
The first common mistake that physicians make with charting is expecting perfection.
Perfectionism is something most physicians have in common, and it served us well in getting the grades and MCAT scores we needed to get a foot in our career door. But perfectionism around charting becomes something that can drive us into the ground.
We can obsess over charts, ruminating over-diagnoses or tests ordered. We go over every note twice, check for spelling, and make sure every sentence has perfect construction.
More than the enemy of the good, perfect is the enemy of done! We simply don’t have the time to sit around and make every note perfect, and focusing on perfection prevents us from finishing notes and moving on.
Perfect is actually the enemy of much more: it is the enemy of career enjoyment, satisfaction, resilience, and well-being.
The antidote for perfectionistic charting involves getting better at just accepting “good enough” charts. There’s an acronym that can be a lifeline here: OHIO. When you Only Handle It Once, you commit to finishing a note without looking back and agonizing over imperfection. This way, you can make more time for activities that will fulfill and sustain you, allowing balance and satisfaction outside of your practice.
2. Being overly self-critical
The second major stumbling block physicians face with charting is self-defeating thoughts. So many times physicians sit down to chart and are besieged with thoughts like:
“I’ll never get these done.”
“I’ve never been very good at all this.”
“Everyone else is so much more efficient than me.”
“I’m not sure I’m even cut out for being a doctor.”
A lot of times, we can think that beating ourselves up is the best way to motivate ourselves to accomplish more. But, in reality, the opposite is true – all these negative thoughts simply erode your motivation and energy.
The more you focus on what you’re doing wrong, have yet to do, and believe you aren’t capable of – the less you’re able to accomplish. The more you focus on your strengths and what you have accomplished, the more energy you have to accomplish more. This is what modern motivational science makes abundantly clear.
While it’s never as simple as flipping the script from self-criticism to self-praise, physicians that learn to be more supportive and affirming with themselves are the ones who become more capable and efficient charters.
3. Going too big
Oftentimes, charting spirals into a huge, identity-forming, make or break part of the career. It can become a measure of our worth as physicians. Sadly, this can turn charting into our nemesis.
When we view charting through this lens, it’s no surprise that it becomes this momentous beast we have to deal with every day – and something that we agonize over and procrastinate.
But the truth is, charting is just something that needs to get done.
Nothing more, nothing less – it’s simply a part of the job. An annoying, time-consuming part of the job – but it’s just another task to be completed. Your ability to chart doesn’t have any bearing on your value or skill as a physician.
Letting go of all of the pressure and weight that we assign to charting helps us let go of all of the intense emotions many physicians experience around charting: anger, frustration, annoyance, bitterness, contempt, and more.
This, of course, makes it easier to get charts done!
You can recover from charting woes when you accept charting for the beast that it is, detach your sense of worth from it, and recognize that just getting charts done is 100 times better than spending time obsessing over them.
In doing so, you’ll be reclaiming your life from the EMR. You’ll also make time for the people you love, be more calm and focused, and live the life you went into medicine to enjoy.
Gail Gazelle is an internal medicine physician and the author of Everyday Resilience: A Practical Guide to Build Inner Strength and Weather Life’s Challenges.
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