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In today’s post, we are going to look at why it’s so much harder to get your charting done at home.
At risk of making a blanket statement, I’d venture that any physician who brings their work home knows it just takes longer.
But sometimes the time spent at home seems to be an order of magnitude greater than if the same work were done at work! Why does something that takes 5 minutes at work take 15 or maybe even 50 at home?!
Read on to explore the multitude of reasons why this plays out.
The Charting Comes Home
It’s no secret that physicians spend a lot of time charting.
In fact, only 27% of our time is spent seeing patients. The rest of the time is spent on all the bureaucratic tasks surrounding that 27%.
Other studies have found that for every hour spent seeing patients, doctors spend two hours charting about it. This 33-67 spread closely aligns with the the 27-73 figure above.
It makes such little sense to have physicians wasting so much time not caring for patients.
Sure, some degree of charting is necessary, but that’s only a small fraction of what’s “required” and charted.
Now when you look at a typical physician schedule you know that patients are booked back to back in ever shrinking appointment time slots.
So when does this charting happen? All the rest of the time outside of those appointments!
This is time that is not accounted for in our FTE calculations and is certainly not reimbursed.
I calculated how much time one of my coaching clients spent at home per chart, and the number was staggering. It worked out to 42 minutes per chart! Forty-two minutes!
No wonder this is such a huge pain point for so many physicians!
I’ve used the above infographic before in my post Charting: The Leading Cause of Physician Burnout.
It shows the percent of EHR work completed based on hour of the day, split between weekdays (solid teal line) and weekends (dashed purple line).
Look at how much time is spent outside of work, most notably weekend nights!
If Paula Cole re-released her hit single only to change the content and title to “Where Have All the Physicians Gone?” I’m sure the music video would be shots of physicians typing away at computers!
Time spent listening to crooning ballads aside, why does work done at home take so much longer?
Let’s find out.
1. Fatigue
This is probably the most obvious category so I figured I’d lead off with it. It’s also one of the meatiest.
After a long day of work spending quite a bit of time on your feet, perhaps even in an OR or ER, you’re just plain old beat tired.
Our jobs can be physically taxing. For me it’s all the stooping and bending and even helping patients get out of chairs or sit up after lying down for exams.
Me trying to wrangle a child to look in their ears.
Surgeons struggle with posture and patient positioning. (Abdominoperineal resections were the worst on my surgery rotation). Heck, even pathologists deal with eye strain and cricks in their necks!
When you’re home, you just want to (try to) relax and recuperate. We all need to rest.
But I think more fatiguing still is the mental and emotional tolls our jobs take on us.
We make thousands upon thousands of decisions daily at work. Each decision involves a set of neurons firing and that takes energy—literal glucose—to accomplish.
Our brains do get tired akin to a muscle fatiguing while running a marathon.
And tired brains are going to experience slower recall meaning they’ll have to dig deeper to pull up the details you’re trying to remember about an encounter.
Further exacerbating this is the competing amount of data from unfinished charts that you’re trying to keep in your working memory so as not to forget relevant details.
Fatigued brains are more likely to make mistakes, and we know this. Consequently, we often spend more time double or triple checking our work.
What does that mean? Charts take longer to close.
Finally, the work of medicine is heavy in an emotional sense.
When we walk with patients in their human experiences, there is pain and suffering that we are told and witness. This is depleting in its own way and contributes to fatigue that slows us down.
2. EHR Access
Not only are you fatigued, but it seems so too is your EHR!
Most EHRs’ remote access leaves a lot to be desired. From crashing more often and lost connections (and losing unsaved work) to general sluggishness and slower response times, getting your charts closed in a timely manner from home can be logistically frustrating!
Is your EHR a barrier to getting your work done at home?
3. Interruptions
You thought interruptions at work were bad? So many more interruptions exist at home!
Anything that pulls your attention away intentionally is an interruption.
Maybe it’s partners, children, pets all vying for your attention. (Is your cat walking across your keyboard as you type an assessment and plan?)
There’s homework help that’s needed, dinner to be served, clothes and dishes to be washed, bills to be paid (assuming you’re a troglodyte not using automatic bill pay online!), and all manner of other various and sundry chores that demand your attention.
Wait, I can pay my bills online!?
Pre-pandemic, there was also this thing called a social life. Maybe your phone still rings?
Interruptions keep you from your charting tasks at hand and so those tasks take more time.
4. Distractions
Distractions also pull your attention away, but differ from interruptions in that they are unintentional.
So instead of a child coming to talk to you, it’s something in your background that pulls your attention away.
How many of you sit in front of a TV with something playing in the background while you try to chart?
If you’re anything like me, then this is more of an interruption because I cannot not watch TV if it’s on. (It’s sort of like a superpower, but almost entirely worthless…and mostly detrimental.)
But for most others, they can have something playing on their TV in the background passively such that they can still work until something specific distracts them.
At home, there are simply way more distractions from which it is harder to isolate yourself.
These contribute to your slower charting.
5. More to Address
If you don’t complete your charts as you go or before leaving work and instead bring your charting home, then you’re simply going to have more material on which to chart.
For example, if you order several labs and an x-ray on a patient and close your chart at work before they result, then they obviously won’t be in your note (other than a mention that they’re ordered). It’s easier to address them as results at a later time.
However, if you don’t complete that chart and get to it hours later at home, then some if not all of the labs may have resulted and the x-ray read. You now will feel obligated to include them into your note AND also still have to write result notes for them.
I’ve found this to be a huge source of never-ending charting.
In fact, I had one coaching client who would stay at work to chart until 9-10pm every night because she didn’t chart as she went and tried to wait for labs to result.
After coaching, she decided to chart along the way and address lab results later. The difference it made: she started getting home at 5:30pm instead!
She felt like her notes were still complete and like she was able to stay on top of labs and current patient status even with this change. She was just enjoying medicine more and the time she now got back with her pre-teen sons.
I know several of you will disagree with me on leaving results out of your note if they’re not back by the time you’re ready to close the chart, but consider that if you really must, you can always addend your note.
And the longer you wait before you close a chart, the worse this gets. What you may have discussed with the patient might not even hold true anymore and/or the plan has already changed in the intervening period, so what do you document now?
The amount of chart review you’d have to do would be daunting. You’ll need to hire a private investigator to do the digging for you. Good thing I know a good one:
(For those of you who didn’t get that, it’s Veronica Mars, lead character in an eponymous TV show about life in her interesting town and prodigious sleuthing skills.)
6. Buffering
No, this is not waiting for your latest internet cat video to load.
In a coaching context, buffering means any activity in which you partake in order to avoid feeling a negative emotion.
You can learn all about buffering here. For the purposes of this post, all you need to know is that buffering overall leads to a net negative in your life even if in the moment it feels good.
So when the negative feelings arise from having to chart at home, you may choose instead to buffer with TV or food. These provide your brain brief hits of dopamine that alleviate that sense of dread or despair.
However, taking time to buffer only further delays completing your charting, which can make you feel even worse and/or cause you to stay up later to complete the work.
7. Burnout
Burnout does encompass fatigue mentioned in the first reason, but is also more.
Recall the three dimensions of burnout:
- Overwhelming exhaustion
- Lack of personal efficacy
- Deep cynicism and detachment from work
If you’re burned out, then you’re going to find it much harder to find the motivation to complete the work. You’re just done. Fried.
I’ve looked at the relationship between charting and burnout here.
8. Subconscious Sabotage
I gave this one a cool name, and it truly does fit. You’ll see.
When you tell yourself that you’ll finish your work at work, you set a constraint on your time whereby you have a specific amount of time to get everything done. Lo and behold, this actually works to force you to get your work done within that time.
If instead you allow work to spill into your home time, you’ve now opened up ALL of your home time as potential work time.
This is Parkinson’s Law at work.
Parkinson’s Law states that work expands so as to fill the time available to it. You can read more about it here.
This is one big reason you work so much slower at home. You’ve already resigned yourself to using up home time which opens up the rest of your day to charting.
Subconsciously, your brain wants to avoid charting (unless you’re one of those weirdos who gets a dopamine release from charting?) so it tells you that you still have time and can put it off. Why not instead do more pleasurable things?
Subconscious sabotage kinda sounds like this. No really, try saying it fast.
Charting at home is a tax on your joy, so akin to actual income taxes, your brain’s strategy is to delay, delay, delay.
But this means you work so much less efficiently, stay up later, or even wake up earlier to get your work done. You forego living your life.
So what’s the most impactful way to avoid this subconscious sabotage and constrain your work to work?
Ahh yes, our good friend charting as you go!
9. Guilt About Living Your Life
Finally, we’ve reached the last reason your charting is slow as molasses when you’re at home!
And that is because you don’t want charting to take up all of your life! You want to enjoy your time outside of work!
And you deserve a break, a respite, a life outside of medicine!
So you participate a little in life things, and end up feeling guilty both ways—you’re not all in on the life stuff because you’re keeping one toe in the charting pool, and, similarly, you’re wasting your time at home charting and not living fully.
Guilt is an indulgent emotion—a feeling we cling to that doesn’t truly serve us. These types of emotions often keep us stuck in no man’s land and get us no traction. In short, they end up making us miserable.
Now there’s always some benefit to indulgent emotions.
In this case, guilt is our penance of sorts, and thus feeling guilty means we care. (Because you can only feel bad if you care, right?)
And so the benefit to the guilt is some small modicum of reassurance to our brains: “at least I feel guilty about it.”
A big reason for this guilt is the culture of medicine, which has established an expectation that we’re to be a monastic order that must live at the hospital (umm…hello, where do you think the term “resident” came from!?) and only exist to work.
This is what our monastic order culture has us do to ourselves.
Spinning in guilt trying to justify your actions both ways is mentally draining, wastes your time, and slows your completion of work.
Perhaps most damaging, it also causes you to generate negative narratives about yourself as someone who doesn’t stick to their word or is unreliable.
Keep the Charting at Work
As we wrap up today, I hope I’ve helped you identify why you’re slower when you chart at home as opposed to work.
If you struggle with having to chart at home, I bet at least a few of these reasons apply to you.
And if you’ve had enough of spending your waking hours outside of work charting, then commit to constraining your work to work!
I was in that boat until I got intentional and developed strategies and efficiencies to finish my work before coming home. I can help you do the same so that you reclaim your time at home for yourself.
Check out my program Charting Conquered where I help physicians and APPs get their work done at work so that they can reclaim their time at home for themselves.
Do you identify with any of these reasons as impacting how expediently you complete your charting at home? Let me know in the comments below.
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