Paperwork, Writing, Notes in Psychiatry

[Thruster]

How much paperwork is there in the daily practice of Psychiatry. Are you guys writing volumes on each patient or is it mostly checking off boxes on forms etc. How does it compare w other fields?

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[peppy]

Are you guys writing volumes on each patient or is it mostly checking off boxes on forms etc.

Somewhere in between. 🙂 As you become more experienced, I think you pick up how to be concise yet still mention all the important details (particularly the details that might be important legally if it comes to that).
The amount of paperwork also depends somewhat on the setting you're in. Bureaucratic practice settings often will have you do a lot of redundant paperwork. It can be annoying, and I certainly don't enjoy paperwork, but it's not so bad that I feel like it's that big of a deal.

 

[digitlnoize]

How much paperwork is there in the daily practice of Psychiatry. Are you guys writing volumes on each patient or is it mostly checking off boxes on forms etc. How does it compare w other fields?

Lots of paperwork in all of medicine. That being said, it really does vary, as peppy said.

I did rotations in a number of settings as a medical student. In some, there are very good staff who take care of most of the "annoying" paperwork, and the doctor's only paperwork was writing notes and orders. Pretty nice gig, actually.

Other places didn't have that, and you had to do a lot more form filling.

Many places are going EMR. At my new residency, we use Epic, which greatly simplifies most physician paperwork (in some ways, at least...although many would disagree with me). It's pretty easy to just have a template that pulls in the relevant data you need for your note, and only have to type a few things.

I would say it's pretty comparable to other fields. There might be a tiny bit more written per patient, but only because on an admission (for example), you have to include all the stuff from a medical admission, PLUS their past psych history, maybe legal history, more extensive substance history, and mental status exam in addition the physical exam. That being said, we *tend* to have more time to spend with patients, and I think at most places, the pace of doing a psychiatric admit is much better than a medical one. Progress notes I think are much easier in psych. Discharge planning can be a huge headache if you don't have a good social worker helping you out, but the paperwork isn't much different.

So, bottom line...it's up to you and the setting you decide to work in.

 

[surftheiop]

also how much you write greatly varies by person even in the same setting, I do chart reviews as part of a research project and in the same clinics some attendings notes are consistently literally 4-5 times longer than others for the same type of appointment. I don't really know enough at this point to know if one is going overboard or if the other is cutting corners though

 

[nancysinatra]

Psych is horrible about paperwork in my opinion, because our notes are ridiculously long (have you ever seen a neurosurgery note?) and we are forever watching our backs and trying to prove a negative, which is that based on our exam the patient is NOT a risk for suicide. Oh and the endless social histories...

Epic doesn't simplify anything, in my opinion. All the stupid "orders" and "entries" that have nothing to do with patient care--they are just time suckers.

One day soon I think they're just going to take the patients out of medicine altogether and have it be 100% paperwork/Epic.

 

[whopper]

IF you don't like paperwork, forget forensic psychiatry. I've been in cases where I had to read several police reports and write reports on the order of dozens of pages long.

And guess what? I really hate report writing because as many of you've seen, I'm a stream of thought writer. I type of what I think. I'm better at that than giving very rehearsed writing. In forensics, you mess up on a report, one little spelling error, and the cross-examining lawyer could spend over an hour on your spelling mistake, trying to make you look dumber than a fifth grader.

But I still love this field. I just got to make sure I keep a supply of blue kryptonite on me in case my weakness is exposed.

 

[digitlnoize]

Epic doesn't simplify anything, in my opinion. All the stupid "orders" and "entries" that have nothing to do with patient care--they are just time suckers.

One day soon I think they're just going to take the patients out of medicine altogether and have it be 100% paperwork/Epic.

I think where Epic helps is that once all of the information is in there for a patient (the endless social histories, for example), you don't have to re-type it. Just pull it in from a prior chart and done.

I love order sets. Love, love, love order sets. Is it as good as it could be? Not by a long shot. But, I think it's still better than most other EMR's, and in most ways, better than paper.

 

[OldPsychDoc]

I think where Epic helps is that once all of the information is in there for a patient (the endless social histories, for example), you don't have to re-type it. Just pull it in from a prior chart and done.

Assuming the prior chart is trustworthy.
And keep in mind that it is really not kosher to pull, say, large chunks of a previous attending's comprehensive assessment and pass it off as your own work--particularly when you didn't even interview to obtain any of that information.

 

[digitlnoize]

Assuming the prior chart is trustworthy.
And keep in mind that it is really not kosher to pull, say, large chunks of a previous attending's comprehensive assessment and pass it off as your own work--particularly when you didn't even interview to obtain any of that information.

Oh absolutely. What we do is to pre-type a note, leaving the HPI, ROS, Exam, etc blank and pulling in the old info. Then we print off a copy and take it with us to see the patient and go over the PMH, Social hx, etc with them (or their collateral) to make sure it's accurate, and update as needed. Some people use the in room computer (there are lots of those), but most seem to print off a copy of the soon-to-be note. Occasionally things will need to be updated, but for the most part it seems to be a system that works fairly well.

 

[vistaril]

Assuming the prior chart is trustworthy.
And keep in mind that it is really not kosher to pull, say, large chunks of a previous attending's comprehensive assessment and pass it off as your own work--particularly when you didn't even interview to obtain any of that information.

what I'll do is leave a space in the hpi to say something like "4 months ago pt was discharged from (hospital) on DrX's service with a dx of SIMD, ASPD, and r/o malingering. Over the course of his hospital stay at that time, at no point were any psychotic symptoms evident and the pt was observed to be interacting with other pts on the unit well. He was often observed playing cards and pool with other pts on the unit. The pt didn't require any forced prns, but he was irritable at times with staff, especially when his requests for controlled substances were denied"

So someone reading that(which I just obtained from an hpi 4 months ago) would tell them A LOT about the pt....much more than what would be known about him based on the few hours he would have been on the service so far.

Also, I'll just copy and paste stuff like psych hx, social hx, etc...and then ask if anything has changed.


emr is great....it allows us to obtain records and hx so incredibly easy. Dont know what I would do without it(probably end up doing a lot of the same stuff that tried and failed the last several admissions.