11 Tips to Keep the Tasks in Your In-Basket Under Control
By Dr. Ted Jablonski, a lifelong performing artist who retired his family practice to focus on sexual medicine and transgender health in Southern Alberta.
Paperwork is a bit of a misnomer. Most of it isn’t on paper anymore. It’s more accurately “tasks” jamming an inbox. Where the term paperwork is still accurate is the “work” part. Digital overload. Mostly time-intensive, this-is-not-why-I-went-to-medical-school, “unpaid,” mind-numbing activity that can erode the most energetic physician.
Early in my training, I saw a “worst of the worst” case scenario. Back when I was a medical student and there were only paper charts, I worked with a rural family physician who was always behind on charting. At the end of the week, he would have multiple stacks of charts in the corner of his office, from floor to ceiling. He would pack them into his 4×4 truck and take them home to complete over the weekend and bring back Monday. Thankfully, he had a truck or it could have been more than one trip! It was a standing joke in the clinic, and I swore I would never be that doctor.
Last year I ran into a family doctor who was my resident years ago. She laughed at all our shared experiences in the clinic and earnestly thanked me for the “one rule” I had drilled into her head. Always, always, always keep up with your paperwork – no matter what.
The equivalent of stacks of medical charts today is of course an inbox full of tasks. I have heard tales of EMRs with over 1,000 tasks waiting patiently for completion. Talk about a recipe for disaster, or more aptly, a fertile ground for physician burnout. What could be more soul-sucking than heading into a weekend or a real vacation only to know that some of this precious time will be taken up finishing off paperwork that has been unfinished for days, weeks or longer?
Call me OCD, but I can’t live like that. A task created is a task seen. A task seen must be a task completed. My inbox has 0 tasks in it right now (I just checked before starting to write this article). It will be true today and tomorrow and until I hang up the stethoscope.
So what are the rules that I try to live by?
- Clinic visits are now! If you are writing your chart notes, try to complete your note while still in the room and at least before you go into the next room. If that’s not possible, catch up as soon as there is a break. If you’re still unable to accomplish, do it immediately at the end of the clinic day before you leave. Catching up on chart notes at home is a bad habit and one that is hard to break, so don’t start!
- Write better (read shorter) clinic visit notes. Be succinct and to the point. What is the assessment? What is the diagnosis? Be as concise as possible about this portion of the notes and fill in the details of subjective, objective and plan with an editor’s eye for “less is more.” We need to write comprehensive notes, but an experienced physician writes in short, pertinent prose.
- Dictate notes. If you want to spend more quality time with your patients, dictate your notes at the conclusion of each visit. Of course, you may have to edit but this can be an efficient process.
- Use templates. If you do the same thing over and over, develop some well written templates and use them. I have templated notes for every subject area in trans and sexual health. I use templated lab reqs, prescriptions, hand-outs, etc. It takes time to make them and they have to be updated at least once a year, but the amount of time they save is immeasurable.
- Use EMR faxes/email whenever possible. If I get an email query or a prescription request, I email/fax it back and bill it all on the EMR without ever generating a piece of paper.
- Use your staff. If there are tasks/paperwork that are full-out administration work, redirect and use your staff. If anything is repetitious and straightforward, make an algorithm and deploy it. There are a lot of tasks that can be delegated and this is a great way to engage staff while taking care of business.
- If you are going to use your staff, train them well. There is nothing more inefficient than multiple messages over a single simple task and, in the end, lack of documentation on whether the task was done. So: “If a patient asks for X,Y or Z, you have the authority to go ahead and do it. Message me to document that the task is completed.
- Forms—fill out only what your staff cannot. Forms of any sort are spawns of Satan that have come to destroy your medical life. Get your staff to actually look at the form and what it is requesting and fill out as much as possible before forwarding to you. Sometimes, a lot can be done, and “filling the remaining holes” is better than starting from scratch. This takes staff with some experience and common sense, but sometimes this only comes from motivating your staff to become that person.
- Complete a task (repeat). Instead of looking on your Instagram or Facebook account during a break between patients, complete a task or two.
- Set tight timelines on medical-legal work. Get pre-payment on all forms and charge as aggressively as your professional medical association posts. If marked “URGENT”—send back with “Pre-payment URGENT!” When payment is received, aim for completion in 48 to 72 hours (yes that tight!). Work is a lot easier and quick when you are in a good mood!
- Reward yourself. Just think, if you kept up with all your paperwork and took a day off, it would truly be a full day off. If you tally up all the monies you make from noninsured services (usually managed by paperwork) and then use this money solely for personal pleasure (e.g., a vacation, a day at the spa) this can turn a relative negative into an absolute positive. I look forward to completing forms as it only grows my slush fund of happiness, which might transform into a new bike or guitar! So, if you take both the paper and work out of paperwork you are left with nothing: a big fat “zero” in your inbox. A heavenly cure for all that ails you!
This article originally appeared in Canadian Healthcare Network on April 12, 2022 and has been republished with Dr. Jablonski’s permission.
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