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Last week we looked at why charting from home takes so much longer. The reasons were divvied up into nine main buckets.
In today’s post, I want to offer you some tips and strategies to handle your home charting most expeditiously.
The goal is to help you spend the least amount of time working at home because you deserve a life outside of medicine.
Creating some space between work and home serves you, your patients, and society at large if it can keep you working a longer career (if you so choose) as a happier physician.
If you want more help with this, then check out Charting Conquered, a hybrid online course and coaching program that is designed to help busy physicians get home with their charting done. Click here to learn more.
Let’s get to the post!
Hold the Line!
I have to make a plug for keeping your work at work as best you can.
This is a classic example of the best offense being a strong defense; here the defense is getting your charts closed at work such that you bring fewer home to complete.
Having gotten that off of my chest, let’s proceed.
They've Breached the First Line of Defense!
Yes, yes, so the charts have made it through your door and into your home. A most unwelcome guest.
It’s like your millennial child (I keep forgetting I’m one of those…sigh), who returns home after college and takes over part of your home telling you they’ll get a job soon. They overstay their welcome but you put up with it.
Unlike your millennial child, at least charting can bring in some revenue (amirite?)!
I’m here all day folks!
I’m just kidding (but my kids had better be reading this!).
Let’s first look at some broad strategies that I’ll then condense into a more helpful list (i.e., scroll to the end for the TL;DR section), shall we?
Do It as Soon as You Can, but Not Too Soon
Is that cryptic enough?
It’s best to get your charts done in a timely fashion as soon after you see the patients as possible for reasons that are obvious (e.g., better for patient care and continuity, easier to do, get paid sooner, etc.).
Your recall is best immediately after the visit and thereafter diminishes rapidly like the value of a new car leaving the dealership lot.
However, you have to temper this with the fact that you’re probably friggin’ exhausted. A tired brain is more likely to make mistakes and will function less efficiently.
So when you get home, give yourself a break. You need it. Take a little time to recuperate and recharge.
Similarly, you probably haven’t had much to eat or drink so attend to those needs.
All that being said, the most important thing to understand is that when you come home your priorities shift…and that’s okay!
You now have different responsibilities to which you must attend such as feeding pets and children and maybe, just maybe, even playing with them.
I’ve said this before somewhere…ahh here!…but I’m not a fan of “work-life balance” because life is not about balance. It’s about priorities that vary within a day as well as day to day.
For example, when you’re at work, your main priority is not looking after your child. No, it’s about seeing your patients. (Now if you get a call about your child and have to leave, that’s a different story—your main priority has changed.)
So keep up with your home priorities so you keep up with your life and other obligations. And do them guilt-free.
Just make sure to deliberately carve out time to complete your charting.
Avoid the Charting Abyss
It’s critical to decide ahead of time what “doing your charts” means every time you sit down at your computer.
You need to define exactly what you will work on. For example, I will write my X number of notes left and review patient calls/messages from yesterday only.
Opening your EHR without a plan of attack is like opening Pandora’s Box: only evil will emanate forth.
Like this demon cat!
Okay, not quite. The EHR is more like a bottomless pit: you could go there to write one note and end up checking 30 other things and come back up for air two hours later wondering what the heck happened.
Your approach must be targeted and focused. If you’re in there strictly to write notes to close encounters, then don’t allow yourself to even click on the inbasket.
Being distracted by everything in the chart is like getting lost in endless cat videos on YouTube, but far less enjoyable.
Park Your Charts
I’m on a roll with these headers, right?
This one is in reference to Parkinson’s Law, which if you read my blog regularly and don’t know by now, shame on you!
Parkinson’s law states that work will take up as much time as is made available for it.
We can hack this fact. How?
Limit the time available to you to complete your charting. Do not nebulously say to yourself, “I’ll get it done later,” because “later” opens up ALL of the rest of your time as potential time to get it done, like I discussed last week.
Tell yourself you’ll do it between 8-9pm, or whatever it may be. Then turn off your phone, grab a glass of water—
Hey, I said water!
—find a quiet place free of TV and other distractions, make it known to those around you and request they don’t interrupt you, and get those charts done!
Imagine you’ve gone to the beach and had to pay for parking. You only had $1.50 to put in the meter (that only takes change, and you have no more), which bought you say two hours of beach time.
There’s an aggressive parking officer on the prowl, constantly checking meters, and you don’t want to get a ticket.
Pretty easy to figure out how you’ll enjoy your beach time and then hightail it back to your car before the meter expires.
In this awkward analogy (a parking meter that only takes change—what?!), the parking officer is your brain and your car is your charting. So you’re parking your charts, like the header suggests.
Perhaps a better analogy is sleep restriction. To treat insomnia, one proven strategy is to limit the number of hours you’re actually allowed to be in bed. Limiting time in bed can help foster healthier sleep instead of laying there for hours on end with no end in sight.
Putting constraints means getting intentional and staying true to those constraints. However, the most important thing is staying true to yourself and working on your charting when you say you will, even if you don’t finish it all.
This is how you generate positive reinforcement and promote good behavior and formation of a habit.
Very nice!
I Like My Meat Well Done, Not My Burnout
I lived in the UK as a kid during the mad cow disease scare. Back then, we started cooking our meat more thoroughly in the hopes that it would kill (in retrospect, denature) what would turn out to be the prions that cause the disease. Unfortunately, prions are hardy bastards, and this strategy did not work.
But to this day I’m a well done kinda guy.
In this way, burnout is like prion disease: you have to fully understand it if you want to prevent it.
If you’re burned out, it’s going to be hard to get your work done. So in this case, you’re going to have to address what’s burning you out.
You can get some insight into this by reading this post on the underlying causes of burnout.
Now, when it comes to mitigating burnout, I’m biased, but I highly recommend physician coaching.
Anecdotally, I’ve seen what it’s done for me and countless other physicians.
Coaching is newer on the scene and is just establishing its evidence base, including the RCT from JAMA in 2019 that I delved into here. But I promise you, it’s way more helpful than being told to be resilient or do online training modules (like trying to cook your meat more thoroughly).
And if charting is what’s driving your burnout, then you should seriously look into Charting Conquered.
Dismantling the drivers of your burnout and restoring yourself will help you get your work done faster, but the best reason to address your burnout is to allow yourself to live a fulfilled life you can enjoy.
Don’t Chart in the Buff
Sage advice—you probably shouldn’t do most things in the buff.
Really I mean if you find yourself buffering, or using a distracting pleasurable activity to try to avoid the negative emotions associated with charting. Examples include mindlessly watching TV, eating, drinking, checking email, scrolling social media, etc.
The pleasure is short-lived and you’re left in a worse spot than before because you’ve “wasted” time.
If you find yourself wanting to buffer, called having an urge, then surf that urge. Recognize it for what it is: your brain’s way of trying to temporarily avoid discomfort by getting you to distract yourself with something pleasurable.
And step into that discomfort. What happens when you allow yourself to feel that discomfort instead of trying to shove it away?
Nothing. That’s right! Nothing.
That discomfort cannot actually hurt you.
It’s like that unsettling sensation when you start racing downward from the apex of a roller coaster. To me, it feels like my stomach has hiatal herniated all the way up to tickle my larynx—it’s very disconcerting for a few seconds.
But on the other side of that discomfort is the joy and thrill of riding the rollercoaster!
Similarly, on the other side of your avoidance of charting discomfort is peace and the knowledge that you can have your time back!
Allowing yourself to feel the urge (that’s trying to derail your plan) while staying in the moment lets it pass through you like the roller coaster sensation.
Do this enough and you’ll blunt the effect of urges until they’re moot points. This will supercharge your efficiency as an indistractable machine!
While I like the message, I have no idea what’s happening here….
Treat Yo Self!
It’s important to appreciate all of the hard work that you do every day.
You may come home from work feeling like a failure because you have a bunch of charts looming over you, but nothing could be further from the truth.
You spent your day helping people. Remember that.
Actually, do more than just remember it. Celebrate it.
Reward yourself for hard work even if you have charts left. Give yourself treats in terms of time to do what you want without any guilt or shame. You’ve more than earned it.
This can help you rest and recharge, avoid needing to buffer, and serve as motivation to further get your work done (by which I mean finish your charts).
The best way to motivate yourself is to…treat yo self some more! Plan your next fun activity or respite as the reward for finishing your charts at home.
You can even turn it into a game where the more expediently you get your charting done, the better the reward.
One Last Pro Tip
This is a short one, I promise.
Avoid trying to remotely log on to your EHR during times of high internet usage in your residence.
Remote connections always seem spotty at best, so don’t add on speed issues of an internet burdened by everyone streaming at the same time such that you risk losing your notes unless you know it’s not an issue for you.
Everyone in your house playing games or watching movies like this online? Then probably not a good time to try to chart. Heck, just go watch the movie with them!
Putting It All Together
I’m going to sum up the salient points here since this post took on a life of its own.
So, how to crush your charting at home:
- Remember you’re human and have human needs. Tend to those first.
- Your priorities at home are allowed to—nay, should—be different than those at work. Show yourself some grace and compassion in navigating them.
- Close those charts as soon as feasible.
- Constrain the work by scheduling dedicated time for it.
- Constrain your focus by planning ahead on what you’ll actually do/touch in the EHR.
- Get the help you need to combat your burnout.
- Become indistractable by calling out any buffering tendencies and learning to surf your urges.
- Reward yourself for your accomplishments.
There you have it!
Again, I strongly encourage you to figure out how to constrain your work to work as much as you can to avoid allowing your work to spill into home time.
If you’re interested in learning the strategies and mindset that will help you to do that, then you should strongly consider checking out Charting Conquered, my signature program that helps physicians get their work done at work so that they can reclaim their time at home for what matters most.
What do you think? What have you tried that has helped you get your work done at home? Let me know in the comments below.
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