A few weeks ago I was having a series of very bad days. Dozens of unfinished notes, news from the powers-that-be about increases to our patient schedules, constant talk about “productivity” and the seemingly endless needs of my patients had left me feeling crazed. For a day or two I even imagined what it might feel like to start looking for another job. I decided that something had to give. So for the past week I’ve been working on writing crappier notes. Not crappy notes, mind you, just a little crappier. There has to be a happy medium between the beautifully detailed–nay, lyrical–documents that I usually produce and the piece-of-shit-not-even-enough-documentation-to-satisfy-an-insurance-audit notes that some of my colleagues write. I’m working on it. I’m tossing out the description of patient’s social situations, substituting things like “significant social stressors” or “grief” in place of stories. Detailed neuro and ortho exams? Forget it. History of complex medical conditions? How about “See previous notes” instead. Does it feel good? Not particularly. But does it feel good to leave on a Friday with 8 notes pending instead of 28? It sure does.
My other anti-burnout strategy has been to farm out more work to the medical assistants and nurses. I’m sure that this has not increased my popularity in the office. Everyone likes the providers that do most of the scut work themselves. And I know that patients appreciate a nice phone call about a lab result or medication change. Sorry, everyone, the nurse will be doing that now. The nurse will be refilling your meds, calling to reschedule your appointment and letting you know that your potassium is low. I’d love to talk to you myself, but…you know how it is. Too busy!
It’s unfortunate that I am working in a system that prizes the number of patient visits over the quality of patient care. It’s unfortunate that the number of times I hear “How come you can’t be my doctor?” in a day has no impact on my salary. It’s unfortunate that I have to cut corners in order to keep myself from losing my mind. But it would be more unfortunate if I had to leave my clinic because of burnout. So I guess I’ll keep trying to be just a little less of a super-nurse.