The Joy Ride of Charting

Frustrated about all the charts you have to complete? Feeling hopeless about your charting situation? I’m here to help! I’ve been there and you have come to the right place!

You are probably thinking, how is charting joyful? Thoughts coming up may be something like: It’s something I HAVE to do. I don’t get paid if I don’t do them. It is the bane of my existence. My clinic day is too long, having to see the whole list of patients, write up all their charts, review test results, call back patients, fulfill administrative duties… and the list may go on and on.

Even though, some days more than other days, you don’t want to touch the charts at all, you will end up having to finish them. At some point. Some institutions and insurance companies set a deadline for when patient charts are supposed to be completed, after you see the patient, or you may get penalized. Joyful is probably a far-fetched, out-of-this-world emotion associated with charting for many clinicians, but it doesn’t have to be dreadful. The time spent on charting can be shortened – yes, it is possible! I AM the living proof! I would like to share with you the road trip to charting on time.

For years, I saw patients mostly in the outpatient setting. I knew that the longer the time passed that I didn’t finish a patient chart, the less details I would remember and the longer it would take me to complete the same chart had I done it right away. So I made it my practice to complete the patient charts the same day I saw the patients. With all the phone calls, chart reviews and everything else in the office, that meant an extra 4 hours of my day after seeing the last patient. Fast forward to the present – as I am writing this – I have cut my patient charting time by 2-2.5 hours a day! I didn’t think it was possible until it actually happened. I am NEVER going back to where I was – miserable, resentful, powerless, and frustrated. I didn’t have control of my clinic day. I felt that I was doing busy work but did not accomplish much.

You can do it too! Let’s dive into the steps of charting more efficiently and going home at a decent hour.

Think of Charting as a Road Trip

This is the road trip of patient charting. Your destination is where you have all your charts completed, your inbox tasks are addressed.

Here’s the outline:

1. Set the destination with time of arrival
2. Explore WHY you set that particular time
3. Determine what kind of fuel you are using for your car
4. Plan the route. Minimize breaks/pit stops (but don’t over-distend your bladder!).
5. Beware of sight-seeing opportunities – which will slow you down.
6. Expect surprises on the way.

Plan the Road Trip

1. Destination – as mentioned above, this is the end of charting for the day.

2. Set the arrival time – let us set the goal for completion of all the charts in the same day. This may seem impossible for some of you for now, but let’s be curious and adventurous – what if it is possible?
   1. Set the goal time for you to finish all the charts. For example, I used to go home past 7 pm and sometimes still had charts to write; I set my eventual goal time to be 5-5:30 pm.
   2. It is ok to set short-term, little goals in the beginning. Something more achievable. I decided to go with the initial arrival (completion) time to be 6:30 pm.
   3. Don’t dwell on your decision too much – make a decision, stick with it and go with it.

Why do you set that goal? What’s the arrival (completion) time to you?

You plan a road trip, wanting to go somewhere, and there may be different reasons. Explore the WHY. I wanted to finish my charts and go home at a decent hour to spend time with my family, and to have some free time for myself.

Really spend time in exploring this about yourself. It is also important to pay attention to the words you are saying. Go with the thought of “I want to finish my charts so I can (spend time with my family)…”, rather than “If I don’t finish my charts on time, I won’t be able to (spend time with my family)…”. At first glance, these 2 sentences seem to convey the same idea, but they generate different emotions in your body. The former thought will generate feelings like hope, empowerment, warmth, etc. – positive emotions. The latter thought will generate feelings of scarcity, urgency (the negative kind), even lack of control – negative emotions.

It is very important to form sentences in your brain, which will generate positive emotions, to be your WHY, as this will affect our next step: choosing your fuel.

What Fuel Am I Using?

A car is more efficient using a high-octane gasoline. On the other hand, a low-octane gasoline is less efficient. If the octane is lower than a car can handle, the car may run fine at first, but before you know it, the car will break down in the middle of the road. That’s why the kind of fuel to use is very important.

Our fuel is from within. The good news is, we get to choose what kind of fuel to use for this road trip!

Efficient fuels are sustainable, generated from positive emotions. Our emotions are affected by what we think. That is why the previous step is so important. A positive thought will generate positive feelings. A negative though will generate negative feelings.

When I think about being able to go home and spend time with my family, that thought generates, love, warmth and connection for me. If instead, I think that I won’t be able to spend time with my family if I don’t finish my charts on time, I feel restricted, lacking and frustrated – like someone is taking something away from me.

Now that you have chosen a positive fuel, let’s get the engine started. Start the engine in a way that will allow us to use the positive fuel throughout the day. This may mean that you have to remind yourself several times a day, or to restart the engine – that’s ok. Nothing has gone wrong. The more we practice it, the easier it is to have the engine remain started.

Engine starter – which is your immediate feelings to tap into the positive fuel. In other words, how do you have to show up to efficiently use the positive fuel and accomplish the set time goal? For me, the starter feelings are usually determined, focused and serving.

Remind yourself throughout the day what your starter fuel and sustainable fuel are.

Plan the Road Trip Route

Isn’t there just one way – finish the charts and the inbox tasks, and that’s it? The short answer is, yes. Now that you have efficient fuels to go with, let’s plan what to do during the road trip.

The efficient way to finish patient charts is to finish each patient chart before you see the next patient. Charting later or at the end of the day (or days later) will take you longer to complete the same chart, at least several minutes per chart. If you have 10 charts to complete at the end of the day, this may potentially and actually easily add an hour to your work day (if not more; I haven’t even factored in the increased fatigue and frustration in the late hours).

Someone may offer that, “…but I have to keep my patient appointments on time. I don’t want the patients to wait too long.” Is this true? Or is this a story you are telling yourself? Is it ok to have the next patient wait for several more minutes, so you can complete the previous patient’s chart, and you get to have more focus and concentration to care for the next patient? Whatever your story is that is preventing you from wanting to finish the chart after seeing each patient, ask yourself if it is absolutely true.

Simplify the patient notes. If you can utilize dictation (not transcription service) for your notes, do it. It’s much faster than typing. Or if you have a scribe, take advantage of him/her. If you are mostly typing your notes, don’t let perfectionism dominate your thinking. Patient notes are there to communicate with other health care providers about the patient; as long as the point is expressed, it does not have to look nice or in complete sentences. Keep the essentials and that’s it.

Minimize the unscheduled breaks. Breaks are events which interrupt your road trip of chart completion. Things like your nurse is asking you about a patient, or a doctor’s phone call, or a staff member is calling you, while you are writing your note. If it is possible, let your staff know to minimize these interruptions to a minimum, unless it is urgent. Delegate as much as possible – to the staff, to your nurse. Your nurse can triage a phone call, and many times may even save you from having to call the patient back. If you keep doing this throughout the day, a couple minutes here and there, it adds up.

Do schedule some breaks. Schedule a time to eat, stay hydrated. Don’t deprive your body of Calories it needs! It is important to take care of our mind and our body. When nature calls for a bathroom break, please go, don’t even debate in your head if you should see one more patient and let your bladder burst (refer to my blog post, “The Overdistended Bladder”). Breaks may be time for you to check the inbox messages, so you can delegate them before staff members leave for the day.

Always pay attention to the clock. If you have 15-minute time slots for each patient, that means in 15 minutes, you are to see the patient and complete the chart. If you run overtime for a patient, either because there are complex medical issues or because of some psychosocial problems, try to limit the visit time of a patient who has simpler issues.

Beware of Sight-Seeing Opportunities

This road trip of charting is not exactly a leisure trip, because we set a timeline, a goal arrival time. Many things can add time to the road trip, and it is important to be on the look out for them.

We talked about the unscheduled and scheduled breaks in the previous section. Set them in a way that you feel works for you.

Some time during the day, you may be distracted from your route. You may want to see the next patient without completing the previous chart. That desire to move on to the next patient may be stronger than you wanting to complete the previous chart. Or you want to take just a little break, take you mind off temporarily from charting. You want to check your emails, phone calls, or social media. Know that your brain will want to go there, the site attractions on the way to your destination. Feels like such a natural thing to do, doesn’t it?

Pay attention! Be alert! These seemingly innocent thoughts will lengthen your charting time. By switching back and forth between charting (or even doing different patients’ charts) and other tasks, it uses more brain power and fuel. You are interrupting the focus and the concentration you need to finish on time, so watch out!

Expect Surprises

Always expect the unexpected, so when a surprising thing happens, you will more likely think that, ok, here’s my surprise of the day – oh that’s what it is. You will tend to feel more calm than if you think that every day is going to be smooth sailing (or smooth ride). When you are calm, you will go ahead and work on it.

For example, a new patient is sent to me from her PCP because she has “abnormal CBC”. Somehow I didn’t get the records in time. My point-of-care machine recorded a white blood cell count over 100,000 and the peripheral smear shows 50% blasts. She was having some trouble breathing. What I initially thought was a straight-forward hematology patient became a hematologic emergency. Things happen, expected and unexpected things, and that’s part of our lives as physicians – that would be my thought. I did not feel flustered. I did not question why it happened to me (if I questioned, it would mean that I thought it should not have happened to me). For this particular (imaginary) patient, I would send her to a hospital with a leukemia center, with the help of my staff, contact the hematologist over there and warn them about a probable need for leukapheresis.  

What if You are Starting with Many Incomplete Road Trips?

In other words, what if you have many unfinished charts. First of all, have compassion for yourself. You did the best you could at that time. Trust that you can finish all the charts timely. Now that you have the essential guide for a great road trip, you can go back to these old, unfinished trips.

I would recommend for you to work on completing the present days’ charts first, practicing the road trip plan. By doing so, you are not adding more unfinished road trips or unfinished charts to your pile. Remind yourself that you are the person who completes the charts on time. Plan what days you will work on these old charts, and plan how much time you want to spend each session. Little by little, the old charts will be history.

Always Getting to Your Destination On Time

As you practice your road trip more and more, the easier it is to finish. As you find yourself consistently achieving your small goal time, set another goal time, say another half an hour earlier. Remember the fuels that drive you.

Imagine when you are always getting to your destination on time. How would you be thinking? For me, there are a few thoughts. I can’t believe I can actually do this! I’m really living. I feel a deep sense of happiness, connection and accomplishment. And I get to feel this every day I work. Even though life is not perfect, and that there are ups and downs, positives and negatives, I would rather choose thoughts which make me feel better, which in turn will generate more productive and positive actions. The results are clear.

I invite you to join me on the other side of charting!