There isn’t enough time in our appointment slots for me to study old records thoroughly, spend time with the patient, and document thoroughly–so I spend an average of two hours and 20 minutes either before or after each clinic day studying charts and taking notes for every patient I will see the next day. (I’m doing this today, on my “day off,” and every Sunday.) This is a tremendous additional workload that I voluntarily take on just so I can both stay on schedule and provide care that I believe is thorough.
How long have you been doing this? Why not cut down the number of patients per day? That doesn’t sound sustainable!
Three and one-half years. I'm an employee and my schedule is set by my employer. My schedule doesn't feel sustainable, but that is primarily due to call. I could handle the clinic over the long-term.
To be fair, I'm the only one in my group who studies charts this way in advance. Most of them spend 30 seconds outside the room glancing at a recent note and then proceed. Their dictated notes are also less comprehensive. When I have to cross-cover I find it difficult to figure out what is going on with their patients. On the other hand, I've had several physicians tell me that they search for an old note from me when they see a new patient.
We have a hospitalist like that; when I see a new patient I look for a note from him.
In my experience, important things are often missed with a more expeditious approach. Guideline-directed therapies are omitted. A statin is prescribed but the patient is already taking one, so the patient then takes both. The med list on the chart turns out to have no resemblance to the meds the patient is actually taking.
In one case, my review of records turned up a scan that showed a thyroid mass months earlier. No one followed up. That's not my area, but I sent the patient to ENT who found thyroid cancer. She is alive today possibly because I spend time studying charts before clinic. I wouldn't have found that with a brief review of a recent note outside the exam door.
BTW, I am far from perfect and not nearly as good as the director of my fellowship program (and never will be). I hate spending extra hours studying charts, and I know good physicians who seem to catch everything while being less compulsive. I'm just not one of them.
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