First, a VERY important note/disclaimer that these tips are NOT to suggest that those struggling with too much clinical responsibility or burnout or moral injury etc can fix everything with a few productivity hacks. I do not want to minimize the fact that many people have a true work overload issue and may be pushed to the max already. Still, for others it may be helpful to optimize a few things so I am sharing these ideas today as they have helped me personally.
The Why: feeling less behind –> burnout prevention; ability to focus better on each patient without feeling rushed –> patient safety and just an overall more pleasant experience for both patient and provider.
IDEAS DISCUSSED IN THE EPISODE:
B+ notes. Not suggesting to be inaccurate or purposefully incomplete. Just suggesting you put the most attention into the most critical parts for patient care (the assessment + plan) and less into the rest, and to make sure you are up to date with current billing-related documentation requirements as it may actually save time.
If at all possible, finish each note before going to the next patient. Not always possible. But sometime it is!
Constant inbox grooming when/if there happens to be a lull. First patient taking a while to get roomed? See how much of your clinical inbox you can handle. Yes, it’s task switching to some extent. But I’d rather do it during clinic hours than later on, and I really think emptying your clinical inbox on a very regular basis ends up saving time (and making patients happier!) in the end.
Pre-write notes while patients are being roomed (even before you attack the inbox!) and use that time to review what is happening with each follow up + review records for each new patient.
On the inpatient side, pre-round thoroughly! You will save time by really taking your time to review labs / notes / prioritize. Do not let feeling like you have to GO GO GO to be efficient prevent you from preparing adequately. Pre-rounding can also help you go in a mindful order that may save time/effort in the end.
Set expectations with patients for when labs result, when/how they will be notified, and how they can ask questions via the electronic portal. I have reduced my ‘results phone calls’ by probably 80-90% by really emphasizing use of the patent portal. That said, if you find the conversation starting to become a back and forth chat, set up a telehealth or formal phone appointment. (I can imagine portal use might be more challenging with older patient populations, but hopefully that will continue to improve with time.)
Chat functions, like EpicChat: set expectations there too! Non-urgent requests (ie, something that could be handled in a few hours) should NOT be interrupting you mid-visit. Discuss (gently) with individuals who do this why it’s better if they use another modality such as an asynchronous staff message.
While in room, I type out the plan while explaining it to the patient, and this serves two purposes – it goes in the after-visit instructions that gets handed to the patient AND it’s pasted into my plan in the note. Less confusion, and it’s one less part of the note that needs writing after the visit.
Don’t waste effort – make a dot phrase! Make sure you have a helpful library of phrases that expand automatically (I am sure other EMRs do this; in EPIC it’s called a dot phrase). If you find yourself writing something frequently that’s a signal it should be a dot phrase. Even logistical instructions (ie about when / where patients will receive results, or my recommendations for adult endos for those who age out) are dot phrases.
Look ahead but not too far. Don’t get bogged down and ruminate on patients scheduled months out. I used to do this. One day at a time feels more manageable. That said, looking ahead a week or so can be helpful and if possible have an assistant call patients to ensure they have completed labs and that we will have access to what we need for the visit.
Plan vacations in advance! Gotta have things to look forward to! Schedule placeholder vacations if needed!
Ask for help – don’t drown. If you are already very efficient but the workload is just too great to do your job in a reasonable number of hours/week, ask for help! I think in that case it would be very helpful to quantify how you are spending your time at work so you can a) provide objective data and b) see where the pain points are (doing more admin-type work that could be done by others? just too many patients? etc).
Very interested in hearing thoughts and for you to share your own favorite tips! I also wonder if/when AI might help make a lot of this note-related advice irrelevant — which would be great!! I just attended a seminar where they marveled about AI-generated graphics but then suggested manually calculating every minute spent in a patient room/documenting/etc. Sigh . . .
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14 Comments
I’m an academic and found the episode really helpful. My takeaways were using templates – I tell students the same thing and I need to figure out text expanders. I use it for grading but not yet for common student questions. A good thing for the summer to do list. And also expectation management – when they’ll hear from me, etc.
It was great to finish Best Laid Plans this morning and then get to hear you again on Deep Questions! Great interview!
Awww! Thank you!!!
You were interviewed on Deep Questions?! By Cal Newport? Which episode? How exciting!
Today’s episode! I know you can’t tell from the show notes but ill definitely link tomorrow!
Loved the episode today! I’m curious how you feel things go during clinic when you have a learner. I know a good resident can make things easier sometimes, but often when I have a learner I spend those bits of time waiting for patients on teaching rather than staying up to date on notes and inbasket. I don’t have someone with me every day, but at least once a week I do, so I feel like there’s always a session where I’m behind at the end of the day. Do you take time out to teach even when you haven’t finished a note? Or do you finish the note first?
Truthfully – I finish the note. I’m often with a resident (maybe 30-40% of the time) and rarely with a student but when they come they come for a month. I do teaching in the room AND when I give resident feedback on their notes when I sign it. I’d rather stay a little later and teach at the end of the day than get behind clinically. I also probably teach residents more about efficiency tactics, work/life stuff, etc than endo . I feel like the endo stuff is easy to look up and they learn by doing/writing notes/getting feedback on their proposed plan. I’m not typically giving mini lectures. Not saying this is right but tends to be my approach.
OMG so timely-I’ve been working on being more efficient in PCP clinic. Challenging to begin with with all the social stuff we have to do, and then, to write a billion notes on top of that.
Things I’ve found works
– I actually stopped doing a detailed prechart. Our clinic has a 30% no show rate (see above: social stuff), and it’s maddening to do all that work for a patient not to come to their appointment. I have a stickey for my own patients with the ongoing issues/what I want to address. For patients I don’t know, usually a day/two before, I tend to just write out the issues that need to be addressed and figure out why they’re coming.
– To that end, my notes are…brief. I’m not over here writing a long history, and end up looping A&P into the ‘Today we discussed’ section. I like bullet points and brief explanations.and focus much much more on the plan/next visit steps
– <3 dot phrases, I have one for everything
– I insist that all my notes be finished by the end of my clinic day/half day. This might mean that I stay later than I'd like, but then I can go home and NOT BE stressed about the 15+ notes to write. It also helps me follow up on labs etc, so much easier when the note is signed and sealed.
– We luckily have colleagues managing our inboxes when we're inpatient, and when I'm on outpatient, I set aside AM time to drink my coffee and do a quick scan of mine and my 'pod'. (5 residents each of whom rotates at a different time through clinic and manages inbasets for the rest of us). I use the AM to use MyChart to send messages back (timed for 8 AM on the next business day!), and then make a list of who needs a phone call or deeper dive
– I use all my spare clinic time to manage that inbasket-20 min here and there adds up!
Great episode! I’m curious if you’ve ever played around with the length of your appointments? Like made your new/follow up appointments shorter or longer to change your workflow.
Hi! Just wanted to thank you for this episode. I’m not in a medical field, but strangely or not so strangely enough, I’ve been seeking a lot of content coming from medical professionals (Emergency Mind podcast is one of my favourite + some medical youtubers doing lifestyle type of videos) as I find it so helpful in terms of prioritizing, organizing, managing stress and workload and even recovery strategies. I am a teacher in a demanding private school and, as odd as it may sound, I find many tips coming from medical professionals quite relatable. So, just a quick word to encourage you to share more tips from your professional world!
I’m an Epic Principal Trainer for a medium sized academic hospital in upstate NY. Just heard you on Cal Newport’s show. I am primarily a trainer to providers, and more than anything want to help them with efficiency so they can “doctor more and computer less”. Appreciate this post, and I’ll check back in as I have bandwidth myself 🙂
oh cool!!!! Yes let me know what you think of the ep! (I’ve only used EPIC!)
Oh, this is an old post but I love it. I’m not a doctor, but I have a job where I do similar things over and over so I have some time-saving tasks.
QuickParts in my desktop Outlook for text blocks I email over and over. I schedule emails too- sometimes I don’t get to emails until the end of the day, but I work in a different time zone than many of my team members, so I schedule the email to be sent during their business hours.
We use Teams a ton in my workplace, I learned how to use PowerAutomate. I don’t do anything too fancy, and my workplace does not have any of the paid features of PA, but I utilize a lot of the free stuff to frontload a lot of my work. For example, I have to check up on projects regularly and it’s basically the same message each time, so I set up a reoccurrence to automatically do that check-in for me. Things like that. I do not keep this secret- I have offered to show people how to do this but it’s often dismissed as “too hard” or I’m told that it does not take that time to do a quick check it. True- but I am the most consistent member on my team re: check-ins to the point that it gets mentioned in my reviews as a positive, and my projects are generally very on the ball because I catch problems early due to my consistent check-ins. Thanks, automation!
oh man! I wonder why others are unwilling to learn the tricks?! Maybe just seems too new/different? I bet as they continue to see you succeed at least some will ultimately catch on!