5 ms·

A family friend was talking to a doctor who was considering quitting. The reason why, at least for that doctor, wasn't really the stress from patients. It was

A family friend was talking to a doctor who was considering quitting. The reason why, at least for that doctor, wasn't really the stress from patients. It was all the damned paperwork and the stress that created.

BouffantJoe 5y ago
I've heard a lot of the same from teachers.
ghaff 5y ago
My primary care doctor dropped me a few years back. He said his solo practice couldn't handle the paperwork of having so many patients so he went to just seeing patients for his specialty. He was admittedly older and had never particularly embraced computers and so forth. (And then my new PCP retired during the pandemic.)
- dt3ft 5y ago
  Isn’t there any software for solo practices out there?
  - JshWright 5y ago
    Obvious bias, since I work there, but Elation Health is very focused on building EHR software that makes it possible for independent primary care providers to be successful and not have to spend hours per day doing paperwork. https://www.elationhealth.com/ https://www.elationhealth.com/ Speaking from personal experience, moonlighting as a paramedic, paperwork is a universal challenge in healthcare (I often spend more time documenting a call than the call itself took from patient contact to transfer of care to the ER). It is shockingly rare for EHRs (regardless of the speciality they focus on) to actively try to make life better for the clinician. That's a large part of why I'm at Elation for my day job; the founders (and therefore the whole company) have a ton of empathy for the doctors (and staff) we serve.
  - ghaff 5y ago
    He was part of a hospital system so he used their software. I know nothing about medical software but my impression is that there is a huge amount of paperwork regardless involving insurance, prescriptions, testing, etc. Stuff is more integrated and electronic than it used to be but there's still a lot of manual interactions, phone calls, faxes, etc.
- pavon 5y ago
  In the 20 years since I've graduated college, the longest I've had the same PCP is 3 years, about half of the remainder I had for 2 years, and the rest I only saw once before they left and I had to change again. Even if they do stay, they have to see so many patients (~1000 per PCP is what I've heard) that they won't remember anything about me, and will be no better at treating me than a doctor pulled at random. For people with chronic conditions a PCP makes sense, for the rest of us it is just another pointless loop you have to jump through.
- mistrial9 5y ago
  almost every single general/primary care Medical Doctor's office in this area of California closed doors after the year 2000 or so.. Paperwork related to insurance billing, and inability to compete with Big Managed Care (Kaiser Health) for work conditions and benefits, is what I heard as reasons.. the offices were empty commercial space, it was noticeable how many there were...
christophilus 5y ago
I've known a few nurses, doctors, and PTs who expressed exactly this sentiment. It's such a stupid problem, too. There's no reason they should have such an onerous burden, and yet they all do. One of the PTs I know spent at least as much time filling out paperwork as he did with patients. This was partly due to the volume of paperwork required by govt / insurance / lawyers / whatever, and partly due to absolutely awful software.
- treeman79 5y ago
  I got badly injured. Everyone refused to do paperwork. Every doctor said it was every others job. I had great disability coverage. (In theory) Result. Spent 2 years trying to work when I couldn’t get out of bed and was mostly blind. All because doctors didn’t want to spend 20 minutes filling out forms. Plus Disability companies lie constantly until various deadlines pass.
  - gbear605 5y ago
    Obviously the doctors should have done the paperwork and you shouldn’t have had to deal with that. But it seems like the root cause isn’t that doctors don’t want to do paperwork, it’s that the insurance is introducing too much paperwork.
henchore 5y ago
During my last physical, the doctor was trying to listen to my symptoms while getting frantically pinged from the hospital or something. I don't blame him at all, but this trend of always-on + interruptions at work is disastrous, I imagine especially so for people like doctors doing extremely high level intellectual work.
nittanymount 5y ago
this is more correct, the medical fields have to do a lot of paperwork to follow rules and avoid issues (legal?) almost half of their time are on charting instead of taking care of patients, paperwork is needed, but in most facilities, it takes too much time, and the workflows are not optimized enough as well...
- hateful 5y ago
  I've always wondered why they don't hire an assistant that JUST does the paperwork/coding for the doctor. They could follow them into room and just take notes (and leave at times when it is appropriate). How much could it cost to pay someone else to do this? Surely less than a doctor makes doing it... It can become its own profession. It's a separate skill - separate from what a doctor should be focusing on. On a side note, it seems that a lot of professions would benefit from having an assistant - a thing that seems to have disappeared - if what I've seen in old movies in shows is to be believed. Another side-case of this is the fact that technical people tend to be promoted into management roles and have to deal with attendance and time-sheets - why not have someone else do it? The work only suffers.
  - opwieurposiu 5y ago
    My kid's pediatrician has a guy that does this. The job title was "Scribe." A little bit crowded in the exam room but you get used to it. The Scribe had a laptop and could look up whatever info was needed while the doc was doing his thing. If a scrip is needed the scribe types it in to the system and then the doc had to read it and approve. Just keeping the docs hands clean from not having to touch a dirty laptop/iPad all the time has a health benefit I bet.
  - pomian 5y ago
    Brilliant suggestion. Some of us still remember the days when we were paid to be creative engineers, solid creative engineers, designing elegant solutions. Didn't know or need to know how to type, design layout of reports, kerning and fonts, didn't keep track of bills and accounts: Just engineering. (Of course report presentation, review and editing were still necessary, not not the actual technical aspects.)
hateful 5y ago
My wife is a PA - here are a few things we've (anecdotally) noticed: 1. A few doctors left practices after they got taken over by a bigger entity and the hoops they had to jump trough weren't worth it, so they retired. 2. The insurance companies - they control EVERYTHING. One thing that happens a lot is that they don't allow her to order an MRI unless she orders an X-Ray first - even if what they're testing for wouldn't show up on an X-Ray. And this slows down the process of diagnosis by days. There are more examples of things like this - things that should be up to the provider, but end up being up to the insurance company (what drug to prescribe or what treatment to pursue first) - it makes no sense (at least from what I hear from her).
gadflyinyoureye 5y ago
The software in this space is terrible. The system is designed for admins not practitioners. For example blood pressure entry is odd with two boxes. Note capture is slow due to needing it be typed rather than written. Sharing out of the core system is onerous. FHIR would be a good idea, but in practice its hard to correlate a patient across the systems. Few hospitals and doctors setup a push notification for when they change a patient's record. Essentially all of the software needs to be redone with a focus on a centralized record tracking system. The rewrite needs practitioners (all of them, not just Docs, but the lowly CNA too) to drive the requirements. Admins should be included, but not the target of day to day UI.
- deleted 5y ago
  [deleted]
bkjelden 5y ago
My partner is an NP, not only is there an astounding amount of paperwork, usually it's done outside of working hours because management took the chunks of the work day that were previously blocked off for doing paperwork and turned them into more patient visits so they could make more money.
pavon 5y ago
Agreed. This article is so off the mark, trying to talk all the ways technology can help this problem without a single sentence retrospecting about any of the problems that shitty EMRs have caused or at least facilitated. The massive increase in charting, and the fact that nurses spend more time on CYA than providing care these days is the number one reason I've heard from nurses who are trying to get out. High patient-to-staff ratios is the second, which wouldn't be quite as bad if it weren't for all the charting.

BouffantJoe 5y ago

I've heard a lot of the same from teachers.

ghaff 5y ago

My primary care doctor dropped me a few years back. He said his solo practice couldn't handle the paperwork of having so many patients so he went to just seeing patients for his specialty. He was admittedly older and had never particularly embraced computers and so forth. (And then my new PCP retired during the pandemic.)

dt3ft 5y ago
Isn’t there any software for solo practices out there?
- JshWright 5y ago
  Obvious bias, since I work there, but Elation Health is very focused on building EHR software that makes it possible for independent primary care providers to be successful and not have to spend hours per day doing paperwork. https://www.elationhealth.com/ https://www.elationhealth.com/ Speaking from personal experience, moonlighting as a paramedic, paperwork is a universal challenge in healthcare (I often spend more time documenting a call than the call itself took from patient contact to transfer of care to the ER). It is shockingly rare for EHRs (regardless of the speciality they focus on) to actively try to make life better for the clinician. That's a large part of why I'm at Elation for my day job; the founders (and therefore the whole company) have a ton of empathy for the doctors (and staff) we serve.
- ghaff 5y ago
  He was part of a hospital system so he used their software. I know nothing about medical software but my impression is that there is a huge amount of paperwork regardless involving insurance, prescriptions, testing, etc. Stuff is more integrated and electronic than it used to be but there's still a lot of manual interactions, phone calls, faxes, etc.
pavon 5y ago
In the 20 years since I've graduated college, the longest I've had the same PCP is 3 years, about half of the remainder I had for 2 years, and the rest I only saw once before they left and I had to change again. Even if they do stay, they have to see so many patients (~1000 per PCP is what I've heard) that they won't remember anything about me, and will be no better at treating me than a doctor pulled at random. For people with chronic conditions a PCP makes sense, for the rest of us it is just another pointless loop you have to jump through.
mistrial9 5y ago
almost every single general/primary care Medical Doctor's office in this area of California closed doors after the year 2000 or so.. Paperwork related to insurance billing, and inability to compete with Big Managed Care (Kaiser Health) for work conditions and benefits, is what I heard as reasons.. the offices were empty commercial space, it was noticeable how many there were...

christophilus 5y ago

I've known a few nurses, doctors, and PTs who expressed exactly this sentiment. It's such a stupid problem, too. There's no reason they should have such an onerous burden, and yet they all do. One of the PTs I know spent at least as much time filling out paperwork as he did with patients. This was partly due to the volume of paperwork required by govt / insurance / lawyers / whatever, and partly due to absolutely awful software.

treeman79 5y ago
I got badly injured. Everyone refused to do paperwork. Every doctor said it was every others job. I had great disability coverage. (In theory) Result. Spent 2 years trying to work when I couldn’t get out of bed and was mostly blind. All because doctors didn’t want to spend 20 minutes filling out forms. Plus Disability companies lie constantly until various deadlines pass.
- gbear605 5y ago
  Obviously the doctors should have done the paperwork and you shouldn’t have had to deal with that. But it seems like the root cause isn’t that doctors don’t want to do paperwork, it’s that the insurance is introducing too much paperwork.

henchore 5y ago

During my last physical, the doctor was trying to listen to my symptoms while getting frantically pinged from the hospital or something. I don't blame him at all, but this trend of always-on + interruptions at work is disastrous, I imagine especially so for people like doctors doing extremely high level intellectual work.

nittanymount 5y ago

this is more correct, the medical fields have to do a lot of paperwork to follow rules and avoid issues (legal?) almost half of their time are on charting instead of taking care of patients, paperwork is needed, but in most facilities, it takes too much time, and the workflows are not optimized enough as well...

hateful 5y ago
I've always wondered why they don't hire an assistant that JUST does the paperwork/coding for the doctor. They could follow them into room and just take notes (and leave at times when it is appropriate). How much could it cost to pay someone else to do this? Surely less than a doctor makes doing it... It can become its own profession. It's a separate skill - separate from what a doctor should be focusing on. On a side note, it seems that a lot of professions would benefit from having an assistant - a thing that seems to have disappeared - if what I've seen in old movies in shows is to be believed. Another side-case of this is the fact that technical people tend to be promoted into management roles and have to deal with attendance and time-sheets - why not have someone else do it? The work only suffers.
- opwieurposiu 5y ago
  My kid's pediatrician has a guy that does this. The job title was "Scribe." A little bit crowded in the exam room but you get used to it. The Scribe had a laptop and could look up whatever info was needed while the doc was doing his thing. If a scrip is needed the scribe types it in to the system and then the doc had to read it and approve. Just keeping the docs hands clean from not having to touch a dirty laptop/iPad all the time has a health benefit I bet.
- pomian 5y ago
  Brilliant suggestion. Some of us still remember the days when we were paid to be creative engineers, solid creative engineers, designing elegant solutions. Didn't know or need to know how to type, design layout of reports, kerning and fonts, didn't keep track of bills and accounts: Just engineering. (Of course report presentation, review and editing were still necessary, not not the actual technical aspects.)

hateful 5y ago

My wife is a PA - here are a few things we've (anecdotally) noticed: 1. A few doctors left practices after they got taken over by a bigger entity and the hoops they had to jump trough weren't worth it, so they retired. 2. The insurance companies - they control EVERYTHING. One thing that happens a lot is that they don't allow her to order an MRI unless she orders an X-Ray first - even if what they're testing for wouldn't show up on an X-Ray. And this slows down the process of diagnosis by days. There are more examples of things like this - things that should be up to the provider, but end up being up to the insurance company (what drug to prescribe or what treatment to pursue first) - it makes no sense (at least from what I hear from her).

gadflyinyoureye 5y ago

The software in this space is terrible. The system is designed for admins not practitioners. For example blood pressure entry is odd with two boxes. Note capture is slow due to needing it be typed rather than written. Sharing out of the core system is onerous. FHIR would be a good idea, but in practice its hard to correlate a patient across the systems. Few hospitals and doctors setup a push notification for when they change a patient's record. Essentially all of the software needs to be redone with a focus on a centralized record tracking system. The rewrite needs practitioners (all of them, not just Docs, but the lowly CNA too) to drive the requirements. Admins should be included, but not the target of day to day UI.

deleted 5y ago
[deleted]

bkjelden 5y ago

My partner is an NP, not only is there an astounding amount of paperwork, usually it's done outside of working hours because management took the chunks of the work day that were previously blocked off for doing paperwork and turned them into more patient visits so they could make more money.

pavon 5y ago

Agreed. This article is so off the mark, trying to talk all the ways technology can help this problem without a single sentence retrospecting about any of the problems that shitty EMRs have caused or at least facilitated. The massive increase in charting, and the fact that nurses spend more time on CYA than providing care these days is the number one reason I've heard from nurses who are trying to get out. High patient-to-staff ratios is the second, which wouldn't be quite as bad if it weren't for all the charting.