A Cure for the Documentation Blues

Greg A. Hood, MD

Disclosures

January 26, 2017

Adding Fuel to the Fires of Burnout

In September, Dr Christine Sinsky and colleagues published an article in Annals of Internal Medicine that examined how physicians in ambulatory care spend their time.[1] Given the expanding documentation requirements that have coincided with the emergence of electronic health records (EHRs) and new health initiatives, they expected to find that clinicians are spending more and more time on documentation. Affirming what many "in the trenches" have intuitively understood, they found that:

During the office day, physicians spent 27.0% of their total time on direct clinical face time with patients and 49.2% of their time on EHR and desk work. While in the examination room with patients, physicians spent 52.9% of the time on direct clinical face time and 37.0% on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.

This is a massive amount of time spent staring at the computer screen. This is also a dramatic increase in computer time for physicians compared with the amounts reported in a study published in the Annals of Family Medicine just a decade ago.[2]

It's difficult for anyone to comprehend the staggering number of hours that today's totals will add up to over a career. When so much time is spent in this manner, it becomes difficult for a physician to stay fresh and focused on the work at hand.

What's not difficult to understand is the mounting wave of discontent fomented by spending endless hours functioning as a drone at a terminal. Dr Sinsky had expected her research to find that the time spent on EHRs and desk work was substantial, but the final results well exceeded her expectations. Two hours of documentation at the office for every hour of face-to-face patient time, plus the additional couple hours at night, are ample fuel to add to the burnout fire which increasingly consumes our profession.

As Dr Sinsky and others attempt to research how to "more responsibly utilize this limited resource [physician time],"[3] those of us living it have to find our best way to cope with and grind through each of these hours. For me, I've found that music works best, in that it can help me remain focused on completing my work as time stretches on. Studies have validated that listening to music does indeed provide measurable benefits in productivity. Music is ubiquitous and its availability, through such services as iTunes and Spotify, is unprecedented. Consequently, we shouldn't be surprised that more and more workers are turning to music to frame one's focus and set a steady cadence to the drudgery.[4]

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