Stop charting evenings, weekends and holidays

I recently interviewed Dr. Sarah Smith by phone. Sarah is a rural family physician in Edson, Alta. Sarah is originally from Australia, but came to Alberta eight years ago with her family to see the wonderful winters and the mountains. Sarah has a story similar to many of you: For 15 years she brought her medical charts and paperwork home to work on them after the kids went to bed. From 7 p.m. until 11 p.m. each evening was typical for weeknights. Of course, this was terrible for her marriage and for family time. A crossroads was reached, and she needed to either figure it out or leave medicine. So, Sarah undertook the difficult task of developing an approach to getting work done during office hours. Sarah is now a certified coach and coaches family physicians and other specialists across Canada and the United States on how to get home with today’s work done. Her program is called Charting Champions. Intrigued, I asked a few questions. How much does Charting Champions program cost? It is CDN$2,400 (including taxes) and there is a payment plan available if needed. Wow. Do you get any pushback about this? Physicians will only purchase this program if they see the value in getting help and support to stop charting at night. More than 300 doctors are enrolled in the program and only one asked for her money back, within a few days of joining, as it was not the problem that she was needing help with. When I was stuck charting at night, not knowing how to get out of that daily loop, I would have paid much more for someone to solve this problem for me. Getting my life back, and leaving medicine at the office at the end of the day has been a priceless transformation. The program cost is additionally considered a professional expense and is a lifetime access program. That means, as physicians change job, pivot because of a pandemic or come back from maternity leave, they can still have access to the support and community for assistance. Physicians could earn the cost of this program within a couple of days of work and it’s priceless to get back your evenings, weekends and holidays. Thinking about annual leave, some doctors have had the experience of taking their incomplete charts with them to the beach! Read Dr. Crosby on: How to love patients with chronic pain So take me through how your system works. Physicians can start by watching the free webinar at www.ChartingCoach.ca. If a physician identifies as wanting a process to help them get home with today’s work done and specific support to their unique needs, then they can sign up for the program at the same time. After purchase, you have access to the training modules within the membership portal, all the coaching call replays and the private supportive community. Each week there is a group coaching call where you can come and get specific help for your unique needs, things like charting, running on time, managing the backlog, managing your team. Each month there is an invited guest coach to cover other topics that are of relevance to our member physicians and their well-being. There are also challenges, like last month we ran a 30-day “inbox challenge.” Physicians identified what result they would like to create with their inboxes and worked steadily to improve their inbox time. Q: Why all the after-hours charting? Many physicians suspect or identify as having ADHD (attention deficit hyperactivity disorder), where they get distracted while trying to type up the chart after seeing the patient. They often lose track of time when with the patient. So they do it at night where there are no limits to time and no distractions. They even give up sleep time. Typically, the clinical environment and the EMR is not designed for physician efficiency. For instance, many doctors work in clinics with workstations with no privacy. Coaching is an opportunity to develop an individualized simple solution. For instance, some set their iPhone to vibrate at 10 minutes, some get their secretary to knock on the door and some put a clock on the wall behind the patient. One doctor puts on big headphones attached to nothing and wears sunglasses. This helps discourage needless interruptions by staff or other doctors. Another uses an empty consultation room. If one approach does not work that is totally fine, part of developing an intentional clinical day is trial and error. The community is a highly valuable part of the program. In this group, you can be honest, have a bad day, fall off the wagon, share stories of things that are working for you and celebrate wins of getting charting done that your clinical day colleagues simply may not understand. Q: What about scribes? They help some doctors but the downside is cost and you have to train them and some scribes are online and these consultation notes may not be available until hours later. There is no one way that is going to work for every physician. If you have a scribe, you need to manage that position to support you rather than adding more work to your day. Q: What about dictation? This is typically being used by emergency physicians, hospitalists and other specialists. Dictation can be a fast way to record the clinical encounter, however, it is always fastest and most efficient to record the consultation directly after each patient. If you do these at the end of the shift or take it home it becomes a large and daunting task that you simply don’t want to do. . . . . . I thanked Sarah for all the info. It’s good to know that charting at night and spending weekends “catching up” does not have to be our permanent reality. Transformation of your clinical day is possible. It is possible to get home with today’s work done, no matter your environment. What do you think? Do you bring charting work home? What solutions have worked for you? Read Dr. Crosby on: Neurologists making housecalls in blizzards

Stop charting evenings, weekends and holidays

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JohnWyatt Crosby

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