Stop Working Twice: The Key to Leaving Work on Time

It is 4:45 pm. You are done seeing the last patient, but your workday is not. There is a virtual pile of unfinished patient charts waiting for you to complete, from previous days and from today. Your inbox is barely touched and it is stuffed. You see the number of messages as “105” and you cringe.

You are supposed to be done with work. You want to go home but you are not finished with your work. You notice the flooding of frustration and anger. Your fatigue is beyond what words can describe, because you have been constantly drained emotionally. This has been a typical day for you. Day after day, you feel even more frustrated, because you are working the extra hours you did not sign up for, because you feel the loss of control over time management. Not before long, you believe that you are stuck and you cannot do anything right.

If you are already at where I described, or if you are close to getting there, I invite you to take a pause. No question you are working hard. You are also doing hard things, dealing with complex situations. One of the biggest problems for many physicians is working twice.

For example, one of my physician clients recently shared with me that she would do the prep work before her clinic day. Preparation is always a good idea. However, she was preparing by writing detailed notes on a piece of paper. She believed that was the best way to know the patient well and to show the patient that she knew them well. She would often scribble more on her paper during the patient’s visit. After the face-to-face encounter, she would transcribe her notes into the electronic medical record.

Imagine doing that twenty-five times a day. I discussed with this doctor that she was doing the same work twice, and it was not necessary. Instead, she could use the pre-chart function to write part of her notes directly in the patients’ charts, while adding or editing in real time while in the exam room with the patient. This way, she avoids writing the same note twice. When she finishes the note, or most of the note right then and there, she saves herself from having to revisit that patient’s chart later on.

Think about the time you are in a patient’s room and you are requested to refill some medications. If you choose to do it later, your brain is occupied with the thought about reminding yourself to refill the meds and to actually do it.

When you do the task once and done, you reduce your cognitive load. You interrupt the accumulation of tasks. You get to protect your energy, and more importantly, your time. Time you cannot go back to. Time you cannot buy back. Efficiency is not just about speed. Yes, it is important to be mindful of your time and understand how much time it takes for you to do a certain task. Efficiency is about eliminating redundancy.

Many physicians, my old-self included, do things twice (or even more times) at work. As the example above, you are doing it twice if you write notes on paper then enter into the EHR. Or if you are jotting partial thoughts then rethinking and rewriting them later. How about starting notes and not finishing them. That happens to many physicians, having the idea that “I’ll get back to it later”. When you re-open the chart, it takes time for you to reorient yourself to where you left off with that patient. That, of course, involves re-reading the chart. That itself takes extra time.

How about when you are reconsidering treatment plans? You have already discussed with your patient in detail the proposed treatment plan, and you are questioning yourself – is it the correct way to do it, or is there a better way? You not only add time but you also add doubt and insecurity to the pile.

What about the inbox messages? Another physician client shared with me that she would open the inbox to see what messages there were. Instead of starting to tackle them, she would get back to it later. “Later” could mean later that day, or days later. Or when you review the results, you do not document or route them properly right away.

Most of us understand that doing the same thing twice takes up more time – so why do we do it? Examine your clinic day. Where are you doing things more than once? Just examine, and do not judge. This is an exercise for you to see areas you can start changing right away.

One of the biggest reasons is the time pressure produced during visits. Many physicians have fully packed schedules. You are doing your best to run on time, or as close to on time as possible. Naturally, you believe that by doing certain things later, such as writing a patient’s note, will allow you to stay as close to on schedule as possible. Think about this – what does it cost you? Your nights and weekends to get back to charting “later”. Another reason is that many EHR programs involve many boxes and clicks. It is easy to feel frustrated about the EHR and you decide to get back to it at another time.

Maybe you are doing it out of habit, without considering the efficiency piece of the puzzle. The physician who was using paper notes before transcribing into the EHR was doing this practice for a long time – until she joined my coaching program.

You may be overthinking things. When you look at the inbox message, you know exactly what to do, but then you have doubts. You go back and forth, thinking about the same inbox message, and finally deciding to go with what you decided on in the first place.

Or you do not have a routine or a standardized workflow. When you get interrupted, you tend to the task that interrupted you before going back to what you were working on.

The cost of doing things twice is more than just the extra time spent, which mounds to hours of extra work. It also costs you mentally. Going back to the same thing twice can drain you gradually with more re-orientation and you are making more decisions than you have to. The more decisions you make, the faster you experience decision fatigue, and the harder it is to focus as the day goes on. Your emotional well-being also takes a toll. When you see that you are hours behind, some of the common emotions are frustration, trapped, discouraged, anxious, to name a few.

What are some strategies to practice “do it once” in clinical medicine?

Avoid using paper notes. Directly record in the EHR. Maximize the patient encounter – do as much documentation in the EHR as possible while in the exam room. If you can do most of the charting while in the room, then you can finish the rest of it quickly, before seeing the next patient. If you are not good at typing, utilize a scribe or dictation.

If you talk about certain topics over and over, create templates and smart phrases for them. Be familiar with your EHR program and discover shortcuts.

Develop a routine for your workflow. For example, I open the chart a certain way, document a certain way, interview and examine the patients a certain way. That eliminates the hassle of having to think about what to do next, which reduces decision fatigue.

When you are in the patient’s room, refill medications and order tests right away. That way, both you and your patient know for sure you actually did it and you do not have to question yourself later.

Set time blocks for inbox messages. You can be flexible. If you happen to have 5 minutes between patients, start reviewing your inbox messages, one at a time, with the intent that however many messages you review, you will complete that many tasks. Re-route and delegate right away. Avoid just checking the messages to see what is in your inbox.

Imagine yourself as the physician who finishes your work on time. That is the future you. Would you “finish it later”? Remember, better done than perfect. And we only need B+ notes.

If you are doing the exercise above and are finding many areas you can improve, it is okay. In fact, that is great. This does not mean you need to work on everything at once. Pick one or two things you think will be most impactful for your time management. For example, eliminate the paper notes. Once you master one or two things, you move on to other things. You will start seeing the difference.

Remember why you want to be efficient, why you want to leave work on time. Beyond efficiency, you reclaim time to rest, to be present with your family and friends and to enjoy practicing medicine again. The major step toward this is to eliminate doing things twice.

Where in your day are you doing work twice? I invite you to start implementing the “do it once” strategy tomorrow. If you want help, I am here.