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Last week, I shared with you the context and impetus that drove me to start charting as I go.
In today’s post, I want to dissect for you the top three limiting beliefs I had about charting as you go that I had to overcome. These thoughts are not unique to me—in fact, you have probably thought, or still think, at least one, if not all, of these thoughts regularly. And bringing them to the forefront is the first step to dismantling them.
So, without further ado….
“It Will Take Longer”
The first big hurdle I had to overcome was the belief that charting as I go would actually take longer and slow me down.
I was overestimating how long a note took if I were to write it in the moment and/or immediately after a visit. That’s because I was comparing it to the only thing I knew at that time: saving my note for the end of the day when it took me a full 15-20 minutes to write one note.
But that’s because I had so much swirling through my head at the end of the day and had to piece together the visit from the after visit summary and orders placed, etc. I was in the headspace of having to get X number of charts closed, which slows you down considerably more than the headspace of just having only a single chart—just the one in front of you—to close.
I was also more tired by the end of the day. Not only was there the normal fatigue from making tens of thousands of decisions (that burn glucose as neurons fire), but I had also taxed my brain even more by trying to juggle and keep important things in the forefront of my mind all day long just so I’d be sure to remember them at the end of the day. Trying to focus on one chart is hard when that focus is competing mentally with all the other encounters and tasks you have to do.
What I didn’t realize was that by writing my note later, I was working against even more obstacles that would slow me down.
Charting as I go means that I don’t have to deal with that mental tax dragging me down all day (and consequently siphoning off bandwidth for every subsequent patient) and I am capturing more of the important details in the moment when everything about that patient is top of mind. When I chart as I go, l make the best decisions and the fastest decisions. Completing a note immediately after a visit takes 2-5 minutes tops, and usually only 2-3 minutes. And probably a third of the time I’ve finished the note before the patient has left the room.
My brain is also “fresher” and less fatigued as I tackle my charts compared to leaving them for the end of the day.
There’s not much brain left at the end of a workday!
Unlearning this belief was all about understanding the reality of the time differentials and dealing with my anxiety about the time it takes to document in the moment, which was driven by the second point.
“I’ll Make Patients Wait Even Longer”
When we’re already running behind in clinic, and the next patient is roomed, we place great urgency on getting to the next room as fast as possible.
Our intentions are good, right? We want to minimize the time they are waiting. That’s a normal inter-relational goal between two people in such a scenario.
However, rushing to the next room without completing the prior chart means I’m bringing that prior mental baggage with me. This slows me down and means I’m giving slightly less of my full attention, which is a disservice to the current patient.
Moving hurriedly also means I’m less likely to pre-chart and agenda set to make the most of the encounter, which invariably ends up slowing me down especially when the unexpected (or by now is it expected?) “oh, by the way…” reason for the visit appears seemingly out of nowhere.
Had I been able to spend a few minutes preparing, then I’d be more likely to extract that “oh, by the way…” issue at the beginning and be better able to allocate my time and set expectations.
When you’re approaching the encounter from a better headspace, then you’ll move through it more efficiently and with better flow. Simply put: you’ll get more done and faster.
Moreover, if I’m taking care of all test orders, referrals, and prescriptions when they’re top of mind, the patient will spend less time overall because they’re not stuck waiting at lab or radiology for me to put in the orders later (since I either forgot or got interrupted). Better still, they’re not showing up to the pharmacy having to call in waiting on their medications.
So looking also at the time as a whole for the patient rather than just their time with me helped me shift this belief.
“It’s Disrespectful to Patients”
This one goes in lockstep with the prior one.
In coaching, we say that time management is actually mind management, and during a clinic day nowhere is this more true than when deciding to finish a chart now before moving on.
The circumstance of a patient waiting is that the patient has waited X number of minutes. The rest of what comes up for us after that is the thoughts we have about that circumstance, which are generally negative and drive negative feelings like worry and anxiety.
For me, the overriding negative thought was the appearance of being disrespectful, and went something like this: “Patient A will think that my being late is me not valuing their time and disrespecting them, and the later I am, the more disrespectful I’m being.”
When I could finally take a step back and realize that that was ME making my tardiness mean something and not necessarily the patient, it was like a lightbulb going off!
I was creating the narrative that was making me miserable, not the patient!
Sitting with that anxiety—that discomfort—in the moment and letting it wash over me without driving my behavior opened up the world of possibility. This was the space that allowed the reflection and exploration of a different path forward, which ultimately became charting as I go.
Sure, some patients would be upset about being late, but even of those only a small minority would be vocal about it.
Turns out most patients are reasonable humans who recognize that our medical culture and system is riddled with barriers (including those that drive up wait times) and are still incredibly grateful when we can use our expertise to care for them.
Please note that I still take strong issue with how our system operates and my trying to excel within the system should not be construed as approval of it! Heck, we’re all trying to do our best in spite of the system.
Additionally, if I can show up as the best physician I can be at that moment with my full attention on my current patient, then I’m giving them the highest value I can and serving them the best I can.
And that’s a sign of complete respect towards them.
When These Dominoes Fell…
Shifting my thinking on these three mindset blocks enabled me to embrace charting as I go, and I haven’t looked back since.
I chart as I go knowing that:
- it doesn’t slow me down, it actually speeds me up
- it doesn’t keep patients waiting longer, it actually helps me move faster patient to patient AND decreases their overall time spent in contact with healthcare
- it’s not disrespectful to patients, it actually enables me to give them 100% of my focus and attention unencumbered by prior patients’ needs, which is how I can best respect them and their time
This is why I promote it unabashedly and encourage all physicians to incorporate it into their clinic days. I think it’s best for physicians AND best for patients.
If you struggle to implement charting as you go or other workflow and mindset shifts in clinic, then I encourage you to register for my free training called Leave Your Work at Work.
You’ll leave with a clear roadmap capitalizing on both strategy and mindset shifts that will enable you to finish your work at work and reclaim your time at home.
I hope this post illuminated for you any similar beliefs and doubts you may have about charting as you go and showed you how you can start to unwind that hesitancy so that you too can enjoy such a powerful workflow strategy. Let me know in the comments section below.
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