Paperwork/desk work/office work and medcine....yes, this is somewhat of a rant

[shezadeh]

At my current job, I spend the majority of my time in a cubicle. I do interact with other people as the need arises, if we are working on something together or if I have questions. However, the bulk of the time, I am sitting in my cubicle...reading stuff. Not to mention, everyone else is in a cubicle too. I mean, it is an office, so yea..

I know this sounds naïve, but please tell me that medicine (may be specialty dependent) is not like this. I know there are some administrative things in medicine, of course, but isn't most of the job involving doing the actual "practice" of medicine?

I honestly do not think I can sit in a cubicle for my whole life. Don't get me wrong, some people like this type of setting, and more power to them. I just feel it doesn't fit my personality, and I feel like medicine is one solution to this, while also tailoring to my interests in anatomy, physiology, pharmacology, etc.

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[beBrave]

At my current job, I spend the majority of my time in a cubicle. I do interact with other people as the need arises, if we are working on something together or if I have questions. However, the bulk of the time, I am sitting in my cubicle...reading stuff. Not to mention, everyone else is in a cubicle too. I mean, it is an office, so yea..

I know this sounds naïve, but please tell me that medicine (may be specialty dependent) is not like this. I know there are some administrative things in medicine, of course, but isn't most of the job involving doing the actual "practice" of medicine?

I honestly do not think I can sit in a cubicle for my whole life. Don't get me wrong, some people like this type of setting, and more power to them. I just feel it doesn't fit my personality, and I feel like medicine is one solution to this, while also tailoring to my interests in anatomy, physiology, pharmacology, etc.

I'm just a pre-med like you but I can empathize with your situation.

 

[shezadeh]

I should have clarified - I am not currently employed in the medical field. Right now I work full time as an engineer, so I was trying to see if medicine had this particular issue regarding lots of office work. I would rather do something a bit more hands on. Yes there is always paperwork, but it's a question of ratio

I know not all engineering jobs are like mine, to be fair.

 

[cabinbuilder]

I'm a family practice doc and I would say that 85% of what I do is "paperwork". I see a patient, as a result of this:

I do the chart note
If admission to hospital I do the H&P, Discharge summary when they go home.
If they are seen in the ER then I do the dictation

All of these have to be proof read and signed.

I write the prescriptions (usually 4 or more)
If there is a problem at the pharmacy, it will have to be pre-authorized or changed to something else (that's another form or Rx).

I order labs on a lab form
I order xrays/CT/MRI on the Rad dept form

If I need to refer a patient then all the dictations have to be done prior to them going and the referral paperwork needs filled out.


When all the labs and reports come back those have to be reviewed and signed as do the charts notes from other docs I have sent the patient's to.

Oh, and don't forget the FMLA, Workman's comp, Insurance paperwork, WIC, Well child forms, Boycout physicals, sports physicals, school physicals, immunizations.

Now, multiply this by 20-25 clinic patients EVERY DAY.


If you don't want to do paperwork, don't be a doctor. We are the thinkers and the documentors, the decision makers.

 

[shezadeh]

I'm a family practice doc and I would say that 85% of what I do is "paperwork". I see a patient, as a result of this:

I do the chart note
If admission to hospital I do the H&P, Discharge summary when they go home.
If they are seen in the ER then I do the dictation

All of these have to be proof read and signed.

I write the prescriptions (usually 4 or more)
If there is a problem at the pharmacy, it will have to be pre-authorized or changed to something else (that's another form or Rx).

I order labs on a lab form
I order xrays/CT/MRI on the Rad dept form

If I need to refer a patient then all the dictations have to be done prior to them going and the referral paperwork needs filled out.


When all the labs and reports come back those have to be reviewed and signed as do the charts notes from other docs I have sent the patient's to.

Oh, and don't forget the FMLA, Workman's comp, Insurance paperwork, WIC, Well child forms, Boycout physicals, sports physicals, school physicals, immunizations.

Now, multiply this by 20-25 clinic patients EVERY DAY.


If you don't want to do paperwork, don't be a doctor. We are the thinkers and the documentors, the decision makers.

What about more interventional specialties? Anesthesia, ENT, ortho, interventional rad, surgery, etc

The issue is not paperwork per say, but more of the stagnant nature of office work/cubicles

Kinda lacking in the human interaction part.

 

[cabinbuilder]

What about more interventional specialties? Anesthesia, ENT, ortho, interventional rad, surgery, etc

The issue is not paperwork per say, but more of the stagnant nature of office work/cubicles

Kinda lacking in the human interaction part.

Doesn't matter what specialty you are in, you see a patient you have to do a chart note, or a procedure note, or a surgery note, or an office note, the pre-op note, the post-op note. We all have paperwork. You cannot be in medicine without doing it everyday. The pathologists dictate their impression, the radiologists dictated their impression, etc.

I have a friend who worked in a large clinic and as IM she had a cubicle. Hated it and quit.

I think in a way the specialists have more per patient: the initial office visit note, then if they go to surgery, the procedure note, then the hospital chart note daily if they stay for any length of time, then the discharge summary from the hospital, then the follow-up clinic visit note for each f/u not to mention if their are complications, etc. and subsequent visits after that.

 

[shezadeh]

Doesn't matter what specialty you are in, you see a patient you have to do a chart note, or a procedure note, or a surgery note, or an office note, the pre-op note, the post-op note. We all have paperwork. You cannot be in medicine without doing it everyday. The pathologists dictate their impression, the radiologists dictated their impression, etc.

I have a friend who worked in a large clinic and as IM she had a cubicle. Hated it and quit.

I think in a way the specialists have more per patient: the initial office visit note, then if they go to surgery, the procedure note, then the hospital chart note daily if they stay for any length of time, then the discharge summary from the hospital, then the follow-up clinic visit note for each f/u not to mention if their are complications, etc. and subsequent visits after that.

I understand, but at least it is different all the time? I don't mind writing or documenting things that I am doing, I did that when I was doing undergraduate research back at school.

My job right now involves mostly trying to see how we are complying with regulations, or following such and such procedure or guideline. It also uses very little of what I went to school for, just bits and pieces.


Maybe I just need to get out more and get some fresh air.

 

[Gfliptastic]

Oh boy.

Everything is moving to Electronic Medical Records. I'm not a resident yet, but I was close to my interns and residents, and they utterly despise all of the seat time they have in front of the computer. Filling out orders. Clicking boxes.

cabinbuilder is right. Just on pure observation, I'd say the residents see the patient for maybe 8 mins tops. They spend 2-3x that on the computer. In the ED, it takes a resident close to an hour to complete an admission. ON THE COMPUTER!

Medicine is all regulatory. Need everything completed and filed properly. Need to be on top of things in many aspects. Insurance companies can ding a hospital for wrong filing. EVEN wrong terminology. Better say "Acute Kidney Injury" instead of "Acute Renal Failure" or that's a ton of $$ gone! Don't forget to call in your dictation X amount of days later. For each patient. If you want to get paid.

Medical students. We are basically "insulated" from the crap-fest that is medicine these days.

So thinking that being a doctor is going to be your escape from regulation and bureaucracy and filing/paperwork - THINK AGAIN!

 

[aerodoc]

I understand, but at least it is different all the time? I don't mind writing or documenting things that I am doing, I did that when I was doing undergraduate research back at school.

My job right now involves mostly trying to see how we are complying with regulations, or following such and such procedure or guideline. It also uses very little of what I went to school for, just bits and pieces.


Maybe I just need to get out more and get some fresh air.

I was a cube farmer (engineer too) before med school. While it is true there seems to be a lot of documenting in medicine, it's not really the same as what you are thinking of. Yes you will spend time in front of the computer, but IMO it's much different than sitting in place for 8 hours a day with your cube mates doing CAD, troubleshooting a mesh, or drafting the minutiae of some part that nobody really cares about that your boss is just going to redline anyway...

Forgot to add, while there are obviously regulatory guidelines etc. in medicine, I used to work in aviation and did a lot of work on certifying parts to FAA standards. Medicine is not really like that either if that's the sort of regulatory work you are doing now.

 

[shezadeh]

I was a cube farmer (engineer too) before med school. While it is true there seems to be a lot of documenting in medicine, it's not really the same as what you are thinking of.

Medicine is not really like that either if that's the sort of regulatory work you are doing now.

Thanks. Glad to hear it isn't quite the same as what I am dealing with right now.

 

[Medicinewoman85]

This is exactly why I value my experience as a ER Scribe.

 

[skico]

.

 

[yossarian444]

I'm a former desk job worker in finance/business world, now an ER resident. Yes, the paperwork aspect of medicine is different than it was in my former life. However, the amount of paperwork involved with medicine is absolutely astounding. Yeah, prior to med school I knew there'd be a lot, but I wasn't fully prepared for this. Even as a medical student you're sheltered from much of the busy work.

I'm at a busy ER. Sadly, I try to limit my time seeing a typical new patient to 5-8 minutes. Any more time than that I fall behind and my patient productivity ratios fall. Most the rest of the time is spent on a computer, putting in orders, checking on labs, reading previous medical records, and most of all, documenting. I guess some time is spent doing procedures and re-evaluating patients, but not much. I try to plow through procedures and re-evaluation of patients as fast as possible. I also try to minimize my time counseling patients and giving their discharge instructions. I leave as much of this as possible to the nurses and to the automated written discharge instruction generator so I have more time to write notes.

It's frusterating. 30 years ago, an ER note could look like this:
"6 year old female comes in with earache and fever for one day. Exam showed otitis media. Antibiotics prescribed and patient to follow up with their primary doctor." (Actually, it'd look more like "6 yo f c/o earache/fever x1d. PE shows OM, rx'd abx and pt to f/u w/ PCP") Simple. Now, the same patient encounter involves literally a 3-page note with a laundry list of things I have to include or the billers will track me down and make me re-write the note so I get all the irrelevant details into the chart for full billing. A lot of the note-writing is automated by checkboxes and dropdowns and macros, but it still takes time to click through it all.

I wouldn't say ER is unique. Even surgical fields have crazy amounts of paperwork.

Again, the desk work is much different than it was in the business world. It is far less challenging the medical world - most of it is simply busywork no matter how you look at it. However, medicine is still fun in certain ways and I do like how the desk work is broken up into bits and pieces separated by new patients and new traumas and whatnot. The day absolutely flies by in the ER and at the end of the day, I do get a smile and a chuckle on my face knowing I helped the bottom rungs of society avoid seeing their primary care doctor for yet another day.

 

[Goro]

Oh, you'll be doing paperwork all right. At least not in a cubicle; see posts above.

Start doing some clinician shadowing so you can see what a doctor's day is like.

At my current job, I spend the majority of my time in a cubicle. I do interact with other people as the need arises, if we are working on something together or if I have questions. However, the bulk of the time, I am sitting in my cubicle...reading stuff. Not to mention, everyone else is in a cubicle too. I mean, it is an office, so yea..

I know this sounds naïve, but please tell me that medicine (may be specialty dependent) is not like this. I know there are some administrative things in medicine, of course, but isn't most of the job involving doing the actual "practice" of medicine?

I honestly do not think I can sit in a cubicle for my whole life. Don't get me wrong, some people like this type of setting, and more power to them. I just feel it doesn't fit my personality, and I feel like medicine is one solution to this, while also tailoring to my interests in anatomy, physiology, pharmacology, etc.

 

[Gfliptastic]

I'm currently in a paperwork driven career. As an attorney my entire job is to create paper in assorted forms. Like you I've given this transition a lot of thought and the way I see it is that in many careers, the creation of paperwork is the job... that is what you do.

My perception of medicine from what I have seen so far is that while there is plenty of paperwork to go around, it is incidental to your actual activities. The paperwork is the necessary evil to accomplishing your goal of patient care. The patient didn't come to you asking for a chart... Rather, they came asking for you to help them get better in some way. The function of paperwork in this context is wholly distinguishable from those careers where your entire occupation revolves around the creation of documents in some way or another.

Just my $.02 and definitely take it with a grain of salt.

Yes, a grain of salt.

Have any of you ever needed a medical clearance? Medical excuse? Prescription? Work physical? If you are a parent, sports physical for your children? Immunization record? Are you consulting for a specialist or are you the specialist? Cuz there's some faxes involved there!

I quoted you because I mildly agree that patients aren't coming to you specifically for paperwork, if you compare it to being an attorney, or other fields. However, there are many ways that patients will "solicit" forms from you as a physician.

The overall tone of using the physician pathway as an "escape" from meticulous notes and paperwork and redtape is probably the most ridiculous reason to quit whatever career any non-trad can have to going thru the hell of medical school/residency.

 

[skico]

Yes, a grain of salt.

Have any of you ever needed a medical clearance? Medical excuse? Prescription? Work physical? If you are a parent, sports physical for your children? Immunization record? Are you consulting for a specialist or are you the specialist? Cuz there's some faxes involved there!

I quoted you because I mildly agree that patients aren't coming to you specifically for paperwork, if you compare it to being an attorney, or other fields. However, there are many ways that patients will "solicit" forms from you as a physician.

The overall tone of using the physician pathway as an "escape" from meticulous notes and paperwork and redtape is probably the most ridiculous reason to quit whatever career any non-trad can have to going thru the hell of medical school/residency.

That's a fair critique and I totally get what you're saying. I'm volunteering and shadowing these days to become better informed. But I maintain that doctors express their professional opinions in ways that are wholly different from more paperwork driven fields. My entire job involves expressing my professional opinion in 20 pages of analysis.

But in any event, I do agree that using medicine as an "escape" from paperwork would be foolish. I'm pursuing it for very different reasons. Plus, there's nothing about lost income, 2 years of prereqs, MCAT, applications, and uprooting my family that feels like an escape. Its just the career that I know I was meant to do and the more I volunteer, shadow, and see what it looks like on a day to day basis, the more I know it's the right decision.