Primary Care: Personal Attention vs. Paperwork

The doctor-patient relationship is emphasized and idolized throughout medical training. Students and residents study and even dream about how they will interview, examine, and relate to their very own patients, when they are attendings.

They do not worry about paperwork.

But every physician deals with loads of paperwork every day. From the ever-more-stringent requisite visit documentation (i.e. charting), reading consult reports and responding to colleagues’ emails, answering patient portal messages, sending results letters, filling out disability and school forms, composing letters of medical necessity, reviewing and signing forms from visiting nurses and physical therapists, digging up the relevant clinical information and then filling in prescriptions for diabetes testing paraphernalia, hearing tests and CPAP machines, completing mandatory population health and institutional training exercises, not to mention maintenance of certification coursework, reading journal articles and clinical updates…

You get the idea. And I left a lot off the list. It is what it is, and it’s a big part of the job.

Now, I like talking to my patients. If there is an abnormal result, or a complicated form to be filled out, or a concerning patient portal message, I prefer to pick up the phone and have a conversation. I can’t do that for every single thing, and our wonderful nurses handle a great deal of triage, as well as results review. But I like to call folks, when I can.

This week, though, was really unusually heavy on the paperwork. Several patients are out on medical leave and requesting short or long-term disability, and it felt like multiple massive piles of forms all at the same time. Then, letters of medical necessity, more than usual. And, many outside discharge summaries and reports that need reviewing. I just couldn’t get to it all. I left the office Friday with a hefty sheath of papers on my desk, unfinished business.

I hate that.

When I get bogged down in paperwork, I ask my nurses to call people about things I normally would call them about myself.

I hate that.

Unfortunately, the paperwork loads are just getting heavier, and it’s crushing the doctor-patient relationship. It’s very difficult to provide the quality care that we envisioned when we were students. Many physicians don’t even look at the patient in the office, because they’re so busy typing and clicking boxes. I have to apologize for this all the time, for interfacing with the screen while my patient is sitting right there.

But if all the blank lines on the forms aren’t filled in, or the orders aren’t entered correctly, or a diagnosis is miscoded, or (God forbid) the billing is screwed up, then the whole encounter comes screeching to a halt. The patient won’t get their referral and/or imaging study and/or lab test and/or medication. Or, the hospital coders and billers will flip out and come after you with a meat cleaver until you fix your mistake because if you don’t, insurance can’t be billed. Et cetera.

Sigh. That’s my rant for the week, folks. I have no answers.