The most popular post on this blog is Charting as You Go, and for good reason. That post captures the single biggest change you can make in your clinic day to cut down your time charting drastically!
In today’s post, I want to share what I was experiencing before I discovered charting as I go because I think it will resonate with how a lot of you are currently feeling.
To Recap the Greatest Thing Since Sliced Bread
Let’s first briefly describe charting as you go.
Charting as you go simply means that you complete all parts of a patient encounter prior to seeing the next patient. That means that the note, after visit paperwork, orders for labs and tests, referrals, medication refills—everything—is done for your current patient before moving on to your subsequent patient.
I ran through an example of how a typical work day may go in the OG post Charting as You Go that really illustrates the power of this strategy.
The benefits are numerous, but the main ones are:
- take care of everything for the patient in front of you while you’re 100% focused on them
- show up to your next patient 100% focused on them
- decrease the chance for interruptions for incomplete care items
- finish your work as you go, preventing the buildup of a backlog
- free up your evenings and weekends, stymying burnout and enjoying your life
I make the argument that charting as you go is best for both your patients AND you!
Moreover, allowing you to live a life outside of medicine (without the constant burden of charting hanging over your head) means you’re more likely to stay working more patient contact hours for a longer career (if you choose!), which is a huge win for society!
So many wins, but maybe not that many.
The Impetus
So how did I arrive at this strategy?
Well, as a newly minted primary care attending, I knew there would still be a steep learning curve for growing my outpatient knowledge base. After all, studies have shown that it takes about 18 months to get comfortable in primary care versus two months for hospitalists coming out of training.
But what I didn’t anticipate was that the larger struggle would actually be completing all the notes and other bureaucratic tasks.
Time spent looking up disease processes, treatment options, and algorithms was in direct competition with getting through the slog of charting.
But doing the right thing for my patients meant subrogating the charting for later. During non-clinical time. During what was supposed to be my time.
My wife and I had been married less than a year before both of us entered the world of primary care. Those first several months of attendinghood were eye opening.
We spent almost every evening and a lot of time on the weekends catching up on notes and trying to chip away at our dreaded inbaskets—we’d finish one portal message or result only to see it replaced by two more!
Kind of like fighting the hydra, only with a mouse and keyboard instead of a sword and shield!
And this was before kids were in the picture. How were we ever going to be able to balance a dual-physician household with having a family?!
After sacrificing a decade-plus devoting ourselves to medicine—thousands of hours honing our craft—this was as good as it was going to get?
This is what we would have to look forward to for the rest of our careers?
It’s an Iceberg Thing
Questions like those were troubling enough. However, it was what lurked beneath that was truly devastating and only recognizable in hindsight.
I started making my inability to finish my work at work mean something about me as a physician and as a person.
If I couldn’t complete my notes or address inbasket items faster, it was because something was wrong with me or because I was deficient in some way. Perhaps I was just too slow or not smart enough? Was I a bad doctor? Hundreds of such negative thoughts flitted through my head as I tried to make sense of the situation.
There were those around me who didn’t seem to struggle with charting so I knew it was possible, but for some reason it was unattainable for me. I would later come to learn that most of those who appeared untainted by charting woes had some other maladaptive coping mechanism, be it ignoring their inbaskets, writing such barebones notes that were not useful, or most commonly just clandestinely taking all their work home because of a fear of being “found out.”
With the benefit of my retrospectivescope, I see that I was tying my self-worth to charting…and feeling like a failure.
The worse my charting backlog became or yet another attempt to remedy the situation failed, the bigger the failure I was and the more I internalized this as part of my self-identity.
It was hard not to do so because charting felt like a Sisyphean task: not only could I not roll that boulder over the hill before it came crashing down, but also that boulder kept getting larger and harder to move as time went on!
At least I’d get some exercise pushing that boulder instead of just sitting typing away at a laptop….
I saw this same phenomenon in my physician friends and family as well as colleagues. Years later, I now see it in my coaching clients, too.
The Night Is Darkest Before Dawn
I don’t remember how the idea of charting as I go came to me. It’s certainly not a novel concept and I am most certainly not its originator (though I suspect I’m in contention for making the strongest, most robust case for implementing it).
What I do remember is that it started as a faint dissonance in my mind when I felt like I had nothing else to try and had resigned myself to spending my evenings and weekends charting endlessly.
It was a simple “what if?” idea that then grew louder and louder until I could no longer ignore it.
What else did I have to lose? I was desperate.
Coming from such a place allowed me to trial it out wholeheartedly and give it my all, which was a blessing. Had I not been in such a predicament, I may have half-assed my attempt which likely would have led to me prematurely terminate the experiment.
I immediately started to see the benefits as I summarized at the beginning of the post. But I intentionally left off the most important benefit, saving it for now:
Success with charting as you go makes you realize that you are not broken—nothing is wrong with you as a physician or person—and gives you a path forward, a path with hope.
Your worth is not tied to your work and certainly not your charting (because you are inherently worthy) AND you deserve a life free from endless charting. Both are true.
Charting as you go is the best strategy I’ve found to make the latter a reality and prove the former to yourself.
Go ahead, tell yourself this—because you do!
Once I was able to see the results (charting at all hours) my actions (not charting after each encounter) created, it became much easier to choose an alternate path forward.
If your charting struggles have left you feeling like a failure and you’re looking to chart an alternate path, then I encourage you to register for an upcoming session of my live free training called Leave Your Work at Work.
It may very well be the turning point in your relationship with charting and give you a new lease on your life and career in medicine!
I hope my journey that led me to charting as I go shows you what’s possible for you. Let me know in the comments section below.
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