The worst part of psychiatry ...

[Doctor Bagel]

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is all these freaking notes. I officially have note writing burnout, which means I'm actually get slower at writing them. How is this possible? This is where third year stinks. Is it just me?

OK, back to writing.

 

[shan564]

During one rotation, I came across a resident who used to type all of his notes and then would just print them onto a regular progress note sheet. I'm just an MS4, but when I'm at residency interviews, I might actually ask them if they'd have any problem with me doing that... seems even more relevant in psych, where our notes have a lot of words and not a lot of drawings/symbols.

I don't see why it'd be a problem... it's faster, more legible, and can be copied directly into EMR (thereby saving us from having to dictate the note later). But I've only seen one person doing it, so I'm guessing that there's some hindrance that I haven't considered yet.

 

[splik]

Do you not dictate them?

 

[OldPsychDoc]

is all these freaking notes. I officially have note writing burnout, which means I'm actually get slower at writing them. How is this possible? This is where third year stinks. Is it just me?

OK, back to writing.

It doesn't get better as an attending... 🙁

 

[Doctor Bagel]

It doesn't get better as an attending... 🙁

Yeah, I thought so.

About writing them, we've got EMR, so typing isn't an issue. We can't dictate, though. I've actually dictated like twice so that's not a faster thing for me to do right now anyway.

 

[hamstergang]

But I've only seen one person doing it, so I'm guessing that there's some hindrance that I haven't considered yet.

Yes, medical records people and administrators get scared when you try to do something different than usual, even if it is better in every way.

 

[notdeadyet]

What EMR are you using, DB? Does it not allow templating and smart phrases?

 

[Doctor Bagel]

What EMR are you using, DB? Does it not allow templating and smart phrases?

Epic and of course CPRS. You know, templates are one thing, but they don't save you from the bulk of the work -- actually writing the content. Concurrent charting doesn't work well for me, either.

Yes, I am being a help-rejecting complaining person in this thread. 🙂

 

[silas2642]

Why don't you type them? I don't think I've handwritten a single note.

 

[Doctor Bagel]

Why don't you type them? I don't think I've handwritten a single note.

I do type them -- just in EMR and not in some separate documentation like shan was mentioning. Handwriting would be horrible.

 

[toothless rufus]

The one-and-only thing that I truly despise (second only to being on call, but that's a given) is: Writing. The. Notes. Ugh. I use dragon but even then they're still draggin'. (Like what I did there?)

 

[sunlioness]

I used to hate dictating. But once I got used to it, it really is faster. I wouldn't say that the note writing gets better as an attending . . . except it does because you're faster/more experienced at it.

Still every now and then they make noise about taking our transcription services away and making us use Dragon. I'm not sure I like that too much. I mean, I'm sure I'd get used to it, but change isn't fun.

 

[Doctor Bagel]

The one-and-only thing that I truly despise (second only to being on call, but that's a given) is: Writing. The. Notes. Ugh. I use dragon but even then they're still draggin'. (Like what I did there?)

Pretty awesome. I don't even know what this dragon stuff is -- dictation is so not a thing here. I think part of my struggle this year is that doing clinic all the time doesn't leave you with open time to do notes as opposed to being on an inpatient ward where you've got time that's not spent talking to patients. I'm moving to the community part of my 3rd year (as opposed to two other VA clinics), and my primary work requirement is not having to write notes.

 

[PikminOC]

I like typing some notes (progress notes) and dictating new pt notes. I use cerner.

 

[toothless rufus]

Pretty awesome. I don't even know what this dragon stuff is -- dictation is so not a thing here. I think part of my struggle this year is that doing clinic all the time doesn't leave you with open time to do notes as opposed to being on an inpatient ward where you've got time that's not spent talking to patients. I'm moving to the community part of my 3rd year (as opposed to two other VA clinics), and my primary work requirement is not having to write notes.

Dragon dictation is a voice recognition dictation program for your computer. I have mine on my laptop. Its a big help. also have it (free app) on my phone, and dictate while driving, then copy and pate and send it in an email then later copy and paste into the EMR.

http://shop.nuance.com/store/nuanceus/html/pbpage.dragon-landing-2012-v2?utm_medium=ps&utm_source=Google&utm_campaign=Dragon&utm_term=dragon_dictation&resid=UJM9FAoBAlkAADODN@cAAABc&rests=1351826708377

No reason to buy the super expensive medical one, as the cheapest one recognizes many medical terms, and its trainable. Perfect for psych. Was a huge relief. Does significantly improve note writing time, and frees your hands. Even if it were slower, it just feels better to me. Less onerous.

Yeah, there's way more time to write notes on inpatient. Clinic, not so much.

 

[PikminOC]

Thank you so much for that link. I thought it would be too costly to get dragon.

You dictate while driving? 😱

 

[toothless rufus]

Thank you so much for that link. I thought it would be too costly to get dragon.

You dictate while driving? 😱

NP. And it can recognize lots of med names. Look for it on sale. I got mine for $80. [edit: oh its on sale now]

Yeah I dictate while driving. Mostly just in the horrendous stop and go traffic on my hour-to-two hour long drive, not too often when traffic is faster. But its not much different than if you were talking to someone. It's nice to bust out a note or two instead of doing them at home.

 

[SuperSoccer19]

Not sure if this is helpful or you do this (most people do this it seems), but I free text all my notes and have made templates to just cut and paste from. I have a blurb for almost all the medications i prescribe that i just cut and paste. I also stopped going into as much detail and often use more bullets. Ill start with an intro (template that I just need to fill in a few demographics), then say "stressors:" and leave it vague, as in "partner relational problems" without going into detail and then have a templated ROS where I add or take things out of. I do this for all parts of the H&P, MSE, etc.

I found it takes much less time and that notes really do not need to be literary works of art--no one cares about the fluff or specifics. As an attending i stopped writing out an impression too--I just do the Axial diagnosis as my impression and write comments on this to explain my thought process.

Has signigicantly cut down the time i spend writing notes since residency.

 

[F0nzie]

As you can see by the above graph, as lack of patience goes up, time it takes to write the note goes down.

 

[Ron Mexico]

i think i wanna hire a scribe on my own dime.