Most/Least Paperwork and Rounding

[GoodDoctor]

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I sense that paperwork will be my least favorite part of medicine. Are there some specialties that do virtually no paperwork, and some that spend the majority of thier time doing it? Can those of you in the know maybe list the top 5 specialties for most and least amount of paperwork.

While we're at it, many people have said rounding is annoying. I'm not sure how I feel about these yet, but am curious how specialties fall in these categories.

Here are my impressions from VERY limited experience. Please make your own list to let me know where my assumptions are right/wrong.

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Most Patient Notes / Paperwork:
1. IM
2. Neurology
3. Pathology
4.
5.

Least Patient Notes / Paperwork:
1. Surgery
2. Anasthesiolgy
3. Radiology
4. EM
5.

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Most Rounding:
1. IM
2.
3.
4.
5.

Least Rounding:
1. Rads
2. Path
3. Anesthesiology
4. EM
5.

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Again, these are my very rough impressions from limited experience. Just to get the ball rolling.

 

[Winged Scapula]

I dunno....my inpatient notes may be shorter than those in IM, but I ALSO have to do pre and post-operative notes, operative notes, lab/path requisitions, etc. I can at least dictate my operative notes, so there is less writing but I think ALL medical specialties have a fair bit of paperwork. I see more patients in a day than a typical FM practice would so I have more notes...fortunately, I can dictate the office visits as well. But I have to review the transcriptions and correct the (oh so often) mistakes.

You'd be suprised at the forms you have to fill out, letters to write, things students often don't see. Don't pick a specialty based on this because you'll have to do it regardless of what field you choose.

 

[Geri_Gal]

Re: Rounding -- IM is notorious for long rounding, BUT work rounds can be efficient and are done once a day. I see the gen surg residents rounding in the wee hours of morning and doing post-op rounds later in the day, too.

Critical care (surg and medicine) rounds tend to be LONG and drawn out as we go through each organ system (gen surg friends tell of rounds that last until 7p.m. b/c the attending breaks to go to the OR...and my critical care IM experience has involved attendings/fellows who LOVE to talk and extemporize on the pathophysiology of sepsis, hypovolemic shock, etc as we round)

 

[mlw03]

pathologists don't round, as they are entirely a consultative service. so i would call path and rad a tie for #1 for least rounding. anesthesia is variable - someone who does critical care would surely round, while someone working in a surgi-center would never round. EM doesn't round, but they do sign-out at shift change so the incoming people know what's going on with the patients already being seen.

 

[leechy]

Path has a lot of paperwork? I was under the impression that they write brief diagnostic reports, but those seem a lot less painful and more to-the-point than the typical IM notes.

 

[elwademd]

you may want to clarify between outpatient and inpatient practice, as well as during residency and post residency life.

with that said, i would imagine that any primary care (i.e. im and fp) would have the most paperwork- social security, disability, dmv forms, off/out of work forms, off/out of school forms, etc.

there are ways to make your day efficient in terms of filling these forms out (which include you not actually filling them out), but that's another subject for another day.

 

[Tone2002]

It seems to be a way to make money to, $25 bucks to fill out forms now by the "doctor".

 

[DarksideAllstar]

Path has a lot of paperwork? I was under the impression that they write brief diagnostic reports, but those seem a lot less painful and more to-the-point than the typical IM notes.

There is quite a bit of paperwork involved in putting together a final path report for a patient. A report typically consists of multiple sections: clinical history, gross descrption of the tumor, final diagnosis line, and a comment section. If it is a rare or exotic malignancy there can be an extensive comment that includes description of the morphology, the differential diagnosis, results of immunohistochemical stains and how they confirm or negate diagnoses in the differential, how the neoplasm should be treated (conservative vs aggressive), and references.

 

[Hard24Get]

EM doesn't round, but they do sign-out at shift change so the incoming people know what's going on with the patients already being seen.

Many academic places also round on 1/2-all the board so that everyone hears about the patients. You can learn quite a lot on rounds, you know (esp in the ICU).

Also, remember that in EM you will see 2-3pts per hour as an attending and will have to write notes on each one.

EM & Surgery rounds and notes are relatively painless (for me) since they emphasize efficiency over pontificating. Anesthesia has to write pre-op & post-op notes, and document vitals, etc throughout the case. Rads you will have to at least dictate all the images you read, which will be considerable.

I think you just have to pick your poison.

 

[RTrain]

Paperwork will be with you in abundance, no matter what you do. Remember that medicine is an industry without a product, so documentation becomes our product. If you want to get paid for what you do, you have to meticulously document what, exactly, it was that you did. Not to mention that other docs are relying on your documentation - patient's condition, your management plans, what was done in the OR, etc.