Stop Physician Burnout - when even a scribe is not enough
I was in New Jersey this week working with a group that has several Scribe Pilot Projects in place. I was talking to the physicians about
- How they use their scribes
- The difference a scribe has made to the experience of their practice
And was shocked by their attitude and observations. I can summarize the conversations as follows:
"Sure ... a scribe is great/amazing/awesome ... AND it is NOT ENOUGH"
WHAT ???!!!
That may come as a shock if you - dear reader - do not have a scribe of your own. I suspect it is especially shocking if you think a scribe is the solution to your own stress at work.
Let me go into more detail here
Scribes are amazingly helpful if you are someone who struggles to keep with your charts in the day. When you have dialed a scribe into your practice well, two things become possible.
- When it is lunch time, guess what will happen - you will eat lunch
- When it is 5:30 - 6:00 PM, guess what will happen - your charts will be done - every day
The doctors I talked to this week were very pleased that both of these were also true for them. The difference between using a scribe and struggling through charting on your own - was night and day. The scribe had made a huge positive difference in how they felt about their practice.
And then the other shoe dropped
Each of these doctors still had a couple hours a day of tasks remaining
- things a scribe couldn't help them with. You can see this coming ... right? All those additional things we often will describe as "death by a thousand paper cuts" or "InBox whack-a-mole".
- Texts
- Emails
- Prescription refills
- Lab and Xray
- Consult reports
- Patient calls and emails
- and more and more and more
Your scribe can't help you with these tasks. The docs did as many of these chores as as possible while they were at work. They had both implemented Team Huddles and Batch Processing. Yet they were still logging on from home at night to work their way piece by piece to the bottom of the daily stack.
When I asked some detail questions ... the EMR itself and the second-by-second activities of digital data entry appeared to be the source of the problem
- Before EMR, each of these tasks was just you reviewing a piece of paper and scribbling your initials. Each one took 10 seconds ... tops. Someone else filed the paperwork for you.
- With EMR, each of these tasks becomes a 90 second click storm diving four screens deep into the software. And in today's reality it is the doctor who is doing the clicking. (CRAZY!!)
Each of these doctors were shocked and despondent to find that even after their scribe had basically eliminated their patient documentation chores, they still faced a soul sucking grind of clumsy EMR data entry that seemed to be inescapable.
Ahh the insanity of it all - What Are Our Priorities??
Do we want doctors to care for patients - or put a spit shine on the data in the EMR?
- Which is more important to the organization?
- Which is more important to the delivery of the highest quality healthcare to our patients?
This is CRAZY and STOOPID and INEFFICIENT and COSTLY and it BURNS OUT DOCTORS
And since administrators cannot understand what it is like to see patients and deal with documentation and these additional streams of data ... we are going to have to figure out strategies for ourselves.
This is only a challenge to our creativity. There is no one coming to save us with a magic bullet of some kind.
We brainstormed potential ways to streamline or offload processing this blizzard of data -- in a search for some kind of Best Practice:
- More effective Batch Processing
- Hiring an "administrative assistant" for each physician allowing the doctor to make the decisions and the clerk does the clicking and posting
- Building a bigger team across your pod by having a floating "documentation clerk" to deal with these chart issues
This is a universal challenge in this era of EMR and Big Data
Let's work together to address it
Rather than falling victim to our Lone Ranger programming ... where each of us tries to figure this out for ourselves ... let's tap into the power of our network here at TheHappyMD.com to find some ways to handle this workload effectively. What say you?
Will you join our search for best practices we can share with our 14,000 subscribers? Here's how to participate ...
If you feel you and your team have mastered one or more of these documentation tasks ... for instance, you and your team have a way to bomb through medication refills and they never slow you down ...
PLEASE LEAVE A COMMENT
When it comes to processing any of these collateral categories of data ... what is working in your practice to do the job well ... so that it does not slow you down or end up as work done at home? We are all ears and thank you in advance for your contribution.