The Charting Trap: Break Free with Efficiency and Rediscover the Joy in Practicing Medicine

As a physician, you work hard. You are doing your best to take care of the patients by talking to them, listening to them, ordering tests and medications, and communicating with other clinicians. And do not forget the patient documentation. If it is not documented, it is not considered done – at least from other clinicians’ view and from the insurance companies’ view. I have coached physicians who are working extra hours after seeing the last patient, spending several hours just to catch up. The thing that is usually pushed off is charting.

The longer you do not finish the patient notes, the less you remember, and the longer it will take you to finish each patient note. Some institutions actually have a deadline to complete the patient charts, usually no more than two weeks from the day you saw the patient. If a physician is constantly exceeding the deadline to finish patient documentation, some institutions may place the physician in some kind of a remedial course or probation. Some may have their salaries frozen until all the delinquent charts are completed.

When you are working as hard as you can, having a hard time to finish your work on time is already hard enough. Having a considerable number of open charts is not something you intend to do. You may be feeling guilty because you think that you did something wrong to not be able to finish the notes. You may be feeling pressured because the administration is breathing on your back to finish the notes as soon as possible, while you are physically and emotionally drained, and cannot possibly find the time to catch up. You may be feeling stuck because you do not see any other way other than sacrificing your sleep. It is not like you stop seeing patients just so you can finish those incomplete patient charts.

Recognize how you are feeling and what the main thought you have about the situation. Acknowledge your thoughts and feelings. Nothing has gone wrong. Let every situation be a learning opportunity. As you have more experiences, you grow to be better. Be kind to yourself. Believe in yourself that you will find a way, which sometimes means asking for help. That is what some remedial programs are for – the help you did not know you needed.

If you are the physician who has unfinished charts from more than one week ago, decide to believe that it is possible to catch up and finish those charts, while completing the charts from the current patients. Finish the charts from the same day first, so you are not adding more unfinished charts to your old pile. You may ask, when is it time for you to finish those delinquent charts? Time is precious. You want to finish the patient charts on time so that you are documenting accurately, other physicians know what your plan is, and you can get compensated for your service.  As much as you want to enjoy your weekends and get some rest in the evenings, it may be a better decision to catch up with all the unfinished charts quickly by doing them over some nights and weekends, depending on how many incomplete charts you have. Once you are caught up, you will have your future nights and weekends back.

It is also time to examine the way you operate during the day. How much time are you actually spending on patient documentation? If that is a big portion of the time, are there ways to shorten the time to complete each chart? Many people will probably say AI scribe. Sure, AI can help with many different things. Go for it if your workplace includes an AI program for scribe. If not, it is still possible to be more efficient than you are now. Are you documenting to the point? Is it easy to understand your findings, your assessment and plan?

The other question to ask yourself is, are your notes clear? When someone else reviews your notes, is it easy for that person to understand what is going on with the patient and what your plan is? When you are documenting clearly and to the point, there will be less questions about your plan. Less questions from others means less inbox messages, and less time to complete your inbox tasks. I find that so true when I am cross-covering for any colleague who is on vacation. When the notes are clear, there are less questions from the nurses about the patients. When it is not clear, I have a hard time understanding the notes or the chronological order of events.

Delinquent charts happen to good physicians. It does not mean you are lazy or you do not care. It just means you are searching for a better way to conduct your clinical day which includes finishing the patient notes on time. In the world of medicine, where high standards are expected, it is easy for you to feel guilty, frustrated, pressured, stuck, or other unpleasant emotions because you are unable to finish the patient documentation on time. It is important to believe that it is possible to finish the charts on time - you just have not figured it out yet. Sometimes the solution may involve asking for help, or someone to guide you to the path of work efficiency. You may have to use some of the nights and weekends initially to catch up with the unfinished notes. Once you are caught up, with increased efficiency, you will not have unfinished notes to complete another day. I did it, and I am helping other physicians do the same. You can get there too!