The Medical Paperwork Tsunami – Hand-written vs. Electronic

It is not unusual for me to receive 50 emails in one day across both my work and personal email accounts, not to mention all of the “snail mail” received both in my work pigeon hole and personal post office box. On top of this “additional” paperwork, the amount of paperwork required for day-to-day consultations, hospital rounds, death certification, etc. seems to be growing by the year.  This huge volume of paperwork serves to add some stress to my already time-poor days as a rural GP.  There has certainly been a turn-around in the amount of snail mail versus email in the last 20 years, and sometimes it can be a nice change to receive a real letterhowever it is more the large volume of material that concerns me!

Snail mail vs. email - then and now

It is almost getting to the point where I think I may need to schedule off additional time during my work day to read articles of interest in Australian Doctor, Medical Observer, Australian Family Physician, and other medical newspapers and journals, in addition to getting through non-consultation-based tasks like results checking, report writing, phone calls to patients and specialists, and completion of the multitude of forms required of us as GPs. A short Australian Doctor article from late 2013 highlighted these issues for GPs, adding that these tasks are not billable by Medicare, and are therefore effectively unpaid.  Sadly, most of the papers and journals I receive end up in my recycling bin, simply because of their sheer volume piling up in my office, after months of not having had a chance to read them.

One morning's pile of papers in GP

One morning’s pile of papers in GP

I do choose to do most of my consultation notes and correspondence via computer (rather than by hand), for several reasons.  Firstly, I am much faster at typing than I am at writing.  I have had multiple patients comment on my speed of touch typing whilst I am looking at them during a consultation.  I was lucky in my timing at high school when typing (“practical information processing”) classes were taking shape, and I learnt to type properly to the point where I now don’t have to think about it.  Secondly, electronic consultation notes and hospital admissions are not only easily legible (which is particularly important when doctors are renowned for having terrible hand-writing), but there is also a time- and person-stamp on the notes.  In addition, if the admission note is written in the GP clinic software and then printed off for the hospital paper notes (which works best for rural GP clinics and hospitals), the notes are then available at the clinic as well as at the hospital, for ease of follow-up.  This time- and person-stamping also works for emails; I find it reassuring to have a “paper trail” of emails which are easily searchable electronically if required in future.

Doctor handwriting - then and nowI would love to hear from other GPs regarding their methods of keeping up with all of the paperwork that comes across our desks and computer screens.

– Do you get time to read journals and medical news articles?

– Do you use Twitter to just skim the headlines?

– Do you set time aside during work hours for administrative tasks, or do you end up working through lunch, and late every night to keep up with it all?

– Do you prefer to type or hand-write your notes?





6 thoughts on “The Medical Paperwork Tsunami – Hand-written vs. Electronic

  1. (i) I type all notes for clinic, type admission note for hospital where possible

    …but sadly hospital will not allow daily ward round notes to be typed and indeed seem to struggle to file ‘admission notes’ in notes, but instead file separately under ‘correspondance’.

    (ii) I use FOAMed to keep up to date as well as browse AusDoc online (comes out sooner than the paper version)

    (iii) I dont bother now with the paper AusDoc, MedObs and associated stuff.

    (iv) unbillable time (checking result, reading letters, following up stuff) takes 30 mins per day on average which I do between rounds and clinic.

    It shits me that Medicare only allows billign for patient contact time – not for associated time.

    (v) medical reports chew up a lot of time, as do requests for GANFYDS

    Given that this occurs outside of clinic time and impedes on my private/family time, then I charge a rate that is commensurate with the fee charged by a lawyer doing acitviity on weekend or after hours – think of an hourly rate, then double it.

    If an organisaiton prefers not to meet that fee then I consier this a win – they can seek a professional opinion from elsewhere and I can spend my time doing fun stuff

    If they insist on a professional opinion, then the fee must match the inconvenience. What are YOU worth to extend working hours into evening or weekend in addition to an already onerous schedule with oncall and clinic?

    (vi) I practice STICKY FINGERS

    If something comes across my desk, there are only three opitions

    – action it
    – delegate it
    – bin it

    Don;t let stuff build up.
    Dont come in on day off to ‘do paperwork’
    Make clear distinction between work and non-work.

    (vii) Finally, work out what you need to survive each year. AS rural GPs we can bill each year sums that seem vast – however must take away expenses, staff fees, tax etc…as well as unpaid fees/bad debts

    Is it worth working an extra 10 hrs per week every week for an extra $xxx,xxx per year?

    Better to work out a sum each year that you need – to meet mortgage, investment, own needs – then work to that.

    Once achieved, back off. Otherwise the taxman takes most anyhow…

  2. Oh – also TRAIN your patients and admin staff

    Only squeeze in extra where life threatening, otherwise defer

    Ensure good triage for after hours work and learn to say ‘no’ to non-urgent call ins (or charge an appropriate fee if patient insists on calling out doctor for a problem that could wait til next day)

    Safety net. Always

  3. Hey Mel

    Thanks for providing a perspective on this!

    Every GP has to work out their individual way of dealing with all the “noise” that distracts us from seeing patients and providing them with evidenced based care.

    If I could just speak on how i’ve just reorganised my life with respect to keeping up with latest issues, new developments and continuing my professional development.

    Like you Mel, I recently passed my exams (take 2 KFP) and took great pleasure at how my mind percolated with knowledge as I saw patients and was able to confidently investigate and diagnose patients.

    But faced with busy clinics, anaesthetics lists, on-call together with being Dad and husband, this doesn’t leave much time for my academic pursuits.

    1) Wake up early – start a morning routine

    What i’ve out is not new but really the key to most successful doctors/ people i’ve met. They have a morning routine! They wake early and dedicate the best part of the day to reading, reflecting and for me, praying and reading my bible and teaching my son maths!

    I am nearly a month into this new change and it has been fantastic. I am able to read the AFP, AD, MJA and NEJM with ease and clarity next to a beautiful and robust cup of coffee.

    2) Pick a few journals

    Two excellent doctors down here in Albany both gave me the same advice, 2 weeks apart. Pick a few key journals and read them! Doctors that read and seek to grow and leaders!

    My picks for GP are: NEJM, Australian Doctor, MJA, Australian Family Physician

    Anaesthetics: CEACCP, Anaesthesia & Intensive Care, Anaesthesia, BJA

    3) Cut out social media

    This is a hard one i know. I am not on FB anymore nor do I tweet. I think I will give twitter a rest for another few months but the last thing I needed was more noise to distract me from the important jobs of being a Dad and husband which has flowed on to being free to read and write more.

    I use feedly to keep up with the medical/financial/church blogs I follow which is enough!

    4) Subscribe to great blogs!

    Get the information right to your front door!

    Waking up early has been the catalyst in my life. I hope that helps someone!


  4. Thank you for this blog.
    At present the one other permanent GP at our practice is away, so I am checking results for both of us. One night last week, at 10pm, still going through the electronic results (both directly electronic and scanned letters), I wondered what sort of job I have got myself into! However, the following day, many satisfying clinical decisions came together much easier as a result of the information I had absorbed the night before. When stuck in front of the computer, I have to constantly remind myself its for the benefit of the patients, not just their blood parameters!
    I wonder if the NHS style of salary would make me feel better or worse about the paperwork?

  5. Agree with all your points here. The only thing I would add is that there needs to be a more consistent implementation of EHR systems, especially in emergency departments when staff are faced with a dichotomy of electronic and paper based notes to complete. I do feel that EHR systems are better implemented in general practice on a whole. For now I will stick to developing websites!

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