This is Part 3 of our Documentation Downfalls series and even though most chiropractors feel like their notes take way too long (what we have defined as a QUANTITY issue), this is Part 3 for a good reason. Here’s why:
Unless you have solved QUALITY problems – i.e. you know how to produce a quality note that meets the requirements (which was Downfall #2) – and unless you have a Treatment Plan that has the correct components (Downfall #1), shortening the time it takes to complete your notes won’t solve the problem as you will still be out of compliance.
In this respect, chiropractors need to focus on Downfalls #1 and #2 first — then work to make their note more efficient. Fortunately (or unfortunately, if you are among the guilty) there are some common mistakes chiropractors mistake that slows down their documentation. Let’s discuss these and, of course, how to fix them:
Bad Habits That Add to Your Documentation Time
“The Entertainer” – too many DC’s feel that part of their job is to make the visit entertaining. As a result, they’ve got some great stories, jokes and amusing anecdotes they like to share with patients. While I’m certainly in favor of creating a bond between the doctor and the patient, some docs take it too far. In fact, if you closely observe them, their stories actually slow them down as they are not likely to stop mid-stream and move to their notes. So they talk and then there’s not enough time to do notes. If this only happened once or twice a day, the doctor loses a few minutes of documentation time. But the chronic offenders are full of great stories that multiply from a few minutes to a half-hour or more throughout the day, adding up to several hours of documentation time down the drain each week.
- Solution: Give yourself a time limit to tell your stories. Be sure that each visit ends on time and/or that you dedicate the remaining minute or two of each visits to getting your notes done – regardless of your story. If that means you need to tell shorter or fewer stories, then do it. You are getting paid to be a doctor not an entertainer. And when you don’t document on time; your notes infringe on your free time.
“The Audience” – sometimes the shoe is on the other foot and the doctor has allowed his or her patients to be the entertainer which results in the doctor becoming their audience. These chatty patients have their own funny stories to share and the doctor allows them to run the visit overtime in order to do so. Big mistake. Now you are running behind and/or your notes are sacrificed on the altar of you being the audience.
- Solution: Learn how to hit the “pause” button on your patient’s stories. Let them know that you look forward to hearing “Part 2” or the rest of the story…on their next visit and then give them recommendations for their return and leave the room.
Vague Visit Finish: Sometimes the visit lingers on unnecessarily simply because there is an awkward place where the patient is not quite sure the visit is complete. And as a result, they will begin talking in that space. Or the doctor will fill it with small talk. This results from the fact that the doctor doesn’t really have a defined end point to the visit and in that gap, fluff and stuff will emerge until the doctor clearly has to go to the next patient.
- Solution: Create a defined end point to every visit. If you are at the adjusting table and finished with your work, give the patient a tap on the shoulder or a verbal interrupt such as “OK” or “Great” or “All Set” and then proceed to give your recommendations. For example: “.Mrs Jones, that neck moved really well today. Let’s continue your plan and we will see you on Friday.” The next move is critical: either begin to write/type your notes or leave the room (where you can go complete your notes).
The Talking Pause: Some chiropractors get in the habit of walking into the treatment room, giving the patient a greeting and then pausing everything to listen to their response. This is completely unnecessary as you can easily be examining your patient AND listening or you can be listening AND taking notes. Once you get in the habit of never standing around talking, you will be amazed at how much time you save.
- Solution: Either Talk and type OR Examine and Listen. If you catch yourself just standing there, go over to your patient and say “Let’s see” and begin palpation, leg check, strength testing or whatever your exam procedures are while they are talking. The patient will still give you the info you need for your ears and your hands can gather more info while you examine.
The Pattern Interrupt: Occasionally, everything goes wrong and the visit is off and running in all directions. The patient is telling stories that have nothing to do with their care or they are giving way too much background info. Or you are telling yours. You get a brief flash of insight that this is not working. You must interrupt the visit flow and begin to get to work.
- Solution: “Pause” the patient and literally stop their story so you can gain control of the visit and begin your examination. A polite but firm. “Hold on, let’s check that.” Or similar interrupting though to their story will help you regain control of a spiraling story. Then quickly get to work.
Inefficient Flow: There are some DC’s whose workflow creates documentation problems. Some waste a minute walking the patient from the waiting room to their treatment area that they could be documenting with. Is there no way the patient can find your room on their own? Are staff not able to show them the way? Other DC’s have a bizarre squirrel-like pattern whereby they enter the room, say “hi” to the patient, jot a few notes, palpate, jot a few notes, run out of the room to get an assistant, come back in, say “hi” again, palpate again, jot some notes again, adjust the patient, go grab something the patient needs from the front desk, show it to the patient, jot some notes, tell a story and then walk the patient out to the front desk so they can come back and jot a few more notes. 227 steps, 431 movements and all is finished.
- Solution: Save your shoes and your sanity and have staff (or the patient) get themselves into your treatment area. Or just pause for a moment and think to yourself: “is there a more efficient way to conduct this visit?” and quit running back and forth. Finally, do some memory exercises and try to remember what the patient has said for more than 30 seconds so that you can avoid multiple trips to jot down your notes. All of this sounds amazingly simple and like common sense and it should be – except that too many chiropractors do this to themselves every day and watch the minutes or hours they could have for their notes just slip away.
Focus on What’s Really Required
In addition to the above, there are some doctors who over-document because they simply don’t know what’s required. Naturally, their notes take way too long. As we mentioned in Documentation Downfall #2, this is actually a Quality problem that manifests itself eventually as a Quantity issue. Fix it fast.
Admit That You Are Not a Super Hero
For some doctors, they finally need to admit that the idea of quality documentation and quantity, efficient notes are just not going to co-exist without some help. A super swift checklist won’t do it. The $15,000 EMR system that you bought didn’t do it. That’s because it’s time to seek some help, get a scribe, put it altogether and conquer your documentation downfalls all in one fell swoop.
The stats are in: I have exactly zero regrets from any of my coaching clients who have integrated a scribe into their practice. On the other hand, I have many who have stated: “Why didn’t I do this before?” Learn from their mistakes (and from virtually every other health professional out there) and get a scribe. You can thank me later J
Still need more help? Consider attending our upcoming Smarter Chiropractic Seminar where we cover every aspect of this series (and more)!