How to recover more time



One of the biggest complaints healthcare professionals continually have is workplace efficiency and administrative burdens. Many physicians, including physician assistants, are happy with their career options but find the paperwork a burden. It’s not just a bit of a drag either, in fact, many healthcare providers report spending several hours a day away from the clinic working on their EHRs. Once we get stuck in the same routines and day-to-day stresses, it can be hard to break this pattern.

Building relationships and expectations with coworkers and patients, as well as more efficient check-in, are two steps to help you get home on time and spend less personal time checking in.

I have worked in psychiatry for the last 13 years; I feel very fortunate that my mentor was a natural expert on efficiency and limits. Since I started in this field, I have been teaching others what I call the golden rule of the workplace.

This simple rule is that you teach other people how to treat you. What this really means is consistency and clear expectations. For example, if you delegate a job or a task, then proceed to do the work yourself, you just taught that person that they don’t need to do it. Although it may have been easier for you to do it “this time,” you’ve set a standard, and once a standard is set, it’s hard to go back.

By not being consistent with communication, expectations are confused. This doesn’t mean that you don’t help out when needed, but rather that you should be aware of if and when you are creating more work for yourself.

team meetings

On a day-to-day basis, team meetings have been shown to help with interprofessional communication and teamwork. You can encourage your team to ask questions, be more prepared for the day, foster healthy team-based relationships, and clarify expectations.

The Agency for Healthcare Research and Quality offers a toolkit that explains what meetings are, how they can be beneficial, and how to set them up.

My workplace rule of thumb also applies to your relationships with your patients, which can be applied from your very first meeting. At the first meeting, I always tell my patients that I will give them enough medication to make it to their follow-up appointment and then ask them to schedule the follow-up before the telehealth appointment is over or before they leave the building.

I also let them know that if they can’t make it, they should call to let us know and request refills if needed. I also tell them the days that I am in the clinic, the days that I am not on call and that the refills will only be filled during normal clinic hours. Then, when they miss an appointment, they have been told to reschedule and ask for refills.

If you find yourself inundated with recharge requests, unnecessary calls, or emails when you’re supposed to be offline, ask yourself, “Have I taught other people to have these excessive expectations of me?”

why we graph

So how do we spend less time plotting and working from home? Let’s go back to the basics of why we graph. Basically, there are three main reasons: first, so you know what you were thinking when you see the patient again; second, so a colleague or other doctors know what you were thinking and when they will resume care if needed; and third, responsibility.

Using templates and dot phrases or keyboard shortcuts are the most common suggestions to help with chart efficiency, but there are other approaches that can be helpful as well.

When I do assessments, in a specialty, I write down all the previous medications that a patient has tried and their responses or adverse reactions. I also write down a list of medications that they have not tried. I keep these lists in a part of my chart that rolls over for each note, so at each quote I don’t have to go back to multiple charts just to see what was proven. I already have a list of medications to consider based on previous responses to medications.

Also, I always make a note in my plan of what I would do next time if what we did today doesn’t work. This helps with pre-registration for the next appointment, as well as if a colleague or someone else resumes care. Eliminate, or at least reduce, redundancies where possible.

If a patient reports symptoms and you document it in the history of present illness (HPI), are you repeating the report in the review of systems (ROS) in such a way that it is redundant? Could you please annotate the ROS to “see HPI” or extract the information from the HPI instead of writing it all over again? This helps you to be aware of how you are documenting. If there is a more concise way to create charts using templates or other forms, take advantage of these tools.

Accountability is really the sticking point. We never want to cut corners here; It is essential to have all the necessary information documented. This goes back to the old adage: if you didn’t document it, it didn’t happen.

How to invoice

You can also pre-chart, which I highly recommend. Starting in 2020, in accordance with the Centers for Medicare & Medicaid Services (CMS) and American Medical Association guidelines for assessment and management coding, you can bill based on time or medical decision-making. If you are billing based on time, the time spent with the patient that day can be included in the billing time. That means the pre-chart time is included. The time includes work done before, during and after the encounter, according to CMS. This can be beneficial in some specialties, but more importantly for the subject at hand, it helps the doctor to be more prepared and therefore more efficient.

Precharting takes little time and helps prevent you from coming in unprepared. It gives you a chance to review the notes and means you can start developing a potential game plan before the patient is seen. It also gives the provider time to review other office notes, labs, images, etc.

If you find that you are having difficulty with the IT aspect or know how to use the system, feel free to contact your management for further training. Remember, they want you to be more efficient, and most of them won’t hesitate to make that happen.

We love what we do, but medicine is a very demanding job, regardless of your role. Unfortunately, many of us wake up one day to find that we are drowning in extra work and wonder how we got to this point. Having clear expectations and limits with your work team and patients, as well as reviewing the efficiency of the EHR are two options to have more time in your personal life and joy in the workplace.

Heidi A. Posey, PA-C, specializes in child, adolescent, and adult psychiatry and is the co-founder of the nonprofit organization The Burn Clinic, which provides burnout education, prevention, and treatment for health care providers.

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