Does psychiatry have the most paperwork?

[Hinglish]

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Hey guys,
I'm pre-med, and I'm going back to med school soon with an interest in psychiatry. I have been a psychiatric counselor for abou four years now. We have a lot of paperwork, but I hear psychiatrists have a ton, more than the average physician. i was just wondering if any residents/attendings/clerkship students could tell me how much paperwork you have in psychiatry? How much of your day is acutally filling out paperwork? Thanks!

 

[whopper]

In my opinion the paperwork has only gotten troublesome in long term care facilities where you got patients there for years and you have to do a 20 year discharge summary, and yes I've had to do one and it was a nightmare.

Or if you're doing forensic reports--because those can be a few to dozens of pages depending on the complexity of the situation. In one Not Guilty By Reason of Insanity Report I wrote, I had to interview 6 people (the prosecutor, defense attorney, the defendant, the witnesses of the event) & read a police report (about 10 pages), the patient's forensic file (about 30 pages), and past charts in the forensic facility in addition to his chart.

Altogether the above task took about 30 hours.

Or if you're doing some complex psychotherapy & analysis, where you need to have the person's entire lifestory. There is an extensive H&P format that can be used in such a setting where you record every major event the person experienced starting from prenatal to the present. (rare)

Short term care facilities and outpatient are pretty much on the order of any other field, and I'd guesstimate that's the majority of psychiatric practice. Long term & forensics are not the bulk of the jobs out there.

 

[OldPsychDoc]

Any amount of paperwork is too much paperwork...but what seems especially heinous are the disability forms, FMLA, return to work letters, etc. I just always find myself thinking "well, yes they WOULD benefit from some time off (but so would I!) but how much, and how best to write that...?"

 

[ronin12]

I think it varies from place to place. i.e priv vs state hosp vs VA.
VA probably has the most paperwork(computer work) as it has computerized medical record and most facilities require psychiatrist to type the initial evaluation and follow up notes. VA also requires multiple clinical reminders to fill on each patient visit .All of which is very time consuming

In short "It is just ridiculous", one of the common phrases you will hear while working in a VA hospital.😡

 

[NJWxMan]

I rotated at a private practice that could have seen double the amount of patients if an EMR was implemented. An initial psych. eval of two pages seemed to be the norm. Follow-up visits consisted of maybe a quarter of a page. Most of the time was spent writing scripts. I'm hoping that once I'm out, that there will be an inexpensive program to create progress notes in 3 mins without any dictation necessary.

 

[MDhasbeen]

I'm hoping that once I'm out, that there will be an inexpensive program to create progress notes in 3 mins without any dictation necessary.

Interns/residents?

There are paper templates used where you just circle mental status exam etc.; but you can't get away from the joys of dictating anywhere without major legal risks.

 

[NJWxMan]

Interns/residents?

There are paper templates used where you just circle mental status exam etc.; but you can't get away from the joys of dictating anywhere without major legal risks.

I plan on typing all of my notes. One major advantage of current medical students is their ability to type.

 

[Solideliquid]

Any amount of paperwork is too much paperwork...but what seems especially heinous are the disability forms, FMLA, return to work letters, etc. I just always find myself thinking "well, yes they WOULD benefit from some time off (but so would I!) but how much, and how best to write that...?"

What I really struggle with are the disability forms. I don't mind filling them out or writing letters for people with severe depression or bipolar disorder, and schizophrenia or MR.

But I really struggle with people who have a moderate or mild affective disorder or dysthymic disorder. And of course, no pressure when patients say "my attorney won't proceed until a doctor fills these out".

 

[whopper]

JCAHO supposedly is requiring that all notes be typed for now on.

There are templates that are emerging in some hospitals. Though it depends on the hospital.

My own hospital is coverting to a template driven progress note which will take months to reach. In the meantime, I type my notes, and use that as a template for the patient on their next note because often times the mental status exam does not abruptly change.

I hear psychiatrists have a ton, more than the average physician

IMHO, most areas of psychiatry are no more paperwork than the other fields except in the cases I mentioned above or in the other cases mentioned. I can remember quite some nightmares in IM where I had a patient in inpatient for 6 straight months, and I only had the patient for the last 4 days of his hospital stay, and then becuase of that I was stuck with doing his discharge summary, and dreading it. It had about 10 doctor's notes in it, and I could not read anyone's handwriting in it, but I somehow had to do a DS on it.

You do anything in the practice of any field of medicine, you're pretty much supposed to document it.

 

[sunlioness]

I type my notes. I also work in a good sized group practice and we have support staff take care of the bulk of the paperwork. So I don't have to do the pre-auths and whatnot. Also they are able to fill out most of the disability and FMLA paperwork from the chart and write any needed letters. I just need to review them and sign it. 🙂