Time spent preparing for next day's clinic

[GrassrootMaltan]

I am a fresh-out-of-fellowship HemOnc working in a hospital-employed community practice setting. I just wanted to know the thoughts of people here as to how long they spend preparing for their clinic patients? I have been spending my entire evening (4-5 hours) preparing for my next day's clinic, going over every chart in detail, reviewing NCCN guidelines and looking up info on UpToDate as I am worried I might miss something. I work 4.5 days a week in clinic and have around 12-15 patients per day so needless to say this is consuming a significant portion of my time and I barely have time for anything else. Is this normal in the first year of attendingship? Will it get better? How long do you spend preparing for your clinic patients? Do you have any tips for me to help make this better? Thanks for your input.

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[whoknows2012]

I am a fresh-out-of-fellowship HemOnc working in a hospital-employed community practice setting. I just wanted to know the thoughts of people here as to how long they spend preparing for their clinic patients? I have been spending my entire evening (4-5 hours) preparing for my next day's clinic, going over every chart in detail, reviewing NCCN guidelines and looking up info on UpToDate as I am worried I might miss something. I work 4.5 days a week in clinic and have around 12-15 patients per day so needless to say this is consuming a significant portion of my time and I barely have time for anything else. Is this normal in the first year of attendingship? Will it get better? How long do you spend preparing for your clinic patients? Do you have any tips for me to help make this better? Thanks for your input.

My initial reaction is;

1) 4-5 hours a day/evening seems excessive. What hours are you working? Let’s say 8-5, are you then doing pre charting 5-10?
2) I assume this will get better as you get to know your patients
3) back to my first observation you’ll need to create a better system so that for 10-15 patients you can get through pre charting in 2h or so (or less as you get to know your patients well) for you own sanity

 

[gutonc]

I've answered this question a bunch of times, but am in a new position to do so now.

6 months ago I was 10 years into a job.

On an average 20-25 patient day, I'd spend 20-30 minutes going through the list like:
"Jim - cycle 3 FOLFOX; Jill - letrozole, mammo looks good; Dave - white count is fine; Liz - C4 TCHP; etc" with 2-3 new patients that would take me 15 minutes or so to review and skeletonize the note. So on a busy day I'd spend an hour or so prepping, do 80-90% of my notes before leaving for the day, and maybe spend another 30-60 minutes cleaning up afterwards including finishing notes and cleaning up my InBasket for the day.

I recently moved to a new position where for the last 3 years there's been a mix of locums, a permanent doc who had logorrhea and a Dragon mic and an NP who is actually quite good but doesn't trust herself. So now I'm back to feeling like a new grad and needing to spend 30+ minutes for each patient I see for the first time recreating the chart and figuring out WTF is going on. The new patients are actually the easy ones since I don't have to play "guess what I'm thinking" with the prior docs.

I've been here for a month and I've already gone from "I need to spend 2h a night prepping for clinic tomorrow" to "F*** it, I've got 30 min with them, I'll spend 10 of it reviewing the chart, another 10 in the room with them and the final 10 writing the note".

Long story short...as Dan Savage likes to say..."it gets better".

4-5h a night is ridiculous. Be more efficient in your review and decision making. This will obviously get better as time goes on, but trust yourself.

 

[GrassrootMaltan]

I've answered this question a bunch of times, but am in a new position to do so now.

6 months ago I was 10 years into a job.

On an average 20-25 patient day, I'd spend 20-30 minutes going through the list like:
"Jim - cycle 3 FOLFOX; Jill - letrozole, mammo looks good; Dave - white count is fine; Liz - C4 TCHP; etc" with 2-3 new patients that would take me 15 minutes or so to review and skeletonize the note. So on a busy day I'd spend an hour or so prepping, do 80-90% of my notes before leaving for the day, and maybe spend another 30-60 minutes cleaning up afterwards including finishing notes and cleaning up my InBasket for the day.

I recently moved to a new position where for the last 3 years there's been a mix of locums, a permanent doc who had logorrhea and a Dragon mic and an NP who is actually quite good but doesn't trust herself. So now I'm back to feeling like a new grad and needing to spend 30+ minutes for each patient I see for the first time recreating the chart and figuring out WTF is going on. The new patients are actually the easy ones since I don't have to play "guess what I'm thinking" with the prior docs.

I've been here for a month and I've already gone from "I need to spend 2h a night prepping for clinic tomorrow" to "F*** it, I've got 30 min with them, I'll spend 10 of it reviewing the chart, another 10 in the room with them and the final 10 writing the note".

Long story short...as Dan Savage likes to say..."it gets better".

4-5h a night is ridiculous. Be more efficient in your review and decision making. This will obviously get better as time goes on, but trust yourself.

thank you very much! good to hear your experience.

 

[GrassrootMaltan]

My initial reaction is;

1) 4-5 hours a day/evening seems excessive. What hours are you working? Let’s say 8-5, are you then doing pre charting 5-10?
2) I assume this will get better as you get to know your patients
3) back to my first observation you’ll need to create a better system so that for 10-15 patients you can get through pre charting in 2h or so (or less as you get to know your patients well) for you own sanity

thank you very much!

 

[IMres85]

I’m 2 years out. Average 18-22 patients a day. I spend about two hours pre charting a day. Of course that does include puttting in orders and such as well. That being said, I’m never in clinic past 5-530 (I do my pre charting at home, so while I finish my work for the day on time, it’s essentially the same as I’m working for the next day)