Some doctors worry about how EHRs slow them down. I worry about how fast they let us go. Too much dropdown makes documentation too easy.
There’s a fine line between efficient and lazy.
Seeing the line is important because when it comes to workflow the drive to completion typically overpowers the obligation to showcase thinking and care. I know because I dance the line every day.
Four things I do to fight the downside of efficiency:
- Recognize that documentation is hard. Good clinical documentation takes work. When it becomes too easy I’ve typically crossed the line.
- Build narrative. My HPI and impressions represent an identifiable stream of thought. I don’t use smart phrases in my HPI or impression.
- Consider the end-user. How does what I create after a clinical encounter serve those who need to see my thinking?
- Stay aware. All of this is a struggle for me. But my discussion and thinking around this makes me aware of it. And that’s the first step to staying on top of it.
All of this discussion is cause celebre for those interested in going back to manilla folders and clipboards. But don’t be fooled. Take any doctor from the analog age, give him a two glasses of wine and he’ll tell you it was easier to take shortcuts on paper. Illegibility and senseless scribbling was our analog pulldown.
Perhaps most importantly, the problem of efficiency needs discussion among medical trainees who are preoccupied with the drive to completion.