Physicians Need to Stop Doing Clerical Work

As physicians, we went to medical school to care for patients, put together a diagnostic puzzle, and give them our undivided attention. We wanted to help people when they were at their most vulnerable. I remember starting my first day as an actual doctor, a pediatric intern. I learned how to take a proper history and physical, documenting all my findings while ordering pertinent tests.  Fast forward 16 years later, and I am thrown into the world of Electronic Medical/Health Records (EMR/EHR).  While the writing was clearer and the orders were transmitted easier, the EMR added a barrier between the doctor and patient. Instead of talking to the patient, most physicians are looking at the computer and typing while taking the patient’s history.  A study in the Annals of Internal Medicine showed that for every hour of direct patient care, physicians are spending 2 hours on paperwork/charting! 

Paperwork from the insurance companies, pharmaceutical per-authorizations and forms designed by non-physicians are overwhelming. Worse, doctors often having minimal support staff who can help complete these forms. Frequently, our staff can only complete so much of the required information and it eventually comes to our desk to fill the gaps. Them we only pray that our patients gets the treatment and/or medications they need. 

The EMR and paperwork issei’s continues to overwhelm physicians with no end in sight. We are training physicians-in-training clerical techniques! They are leaning to click unnecessary boxes which have no bearing on the quality of patient care. Not surprisingly, this adds to physician burnout.  We are frustrated and overwhelmed by tasks that take us away from patient care which is the thing we love to do. We end up losing perspective on what is the meaning of our careers.  Instead, we are forced by hospital systems, insurance and pharmaceutical companies to to meet meaningful use criteria. The result is that physicians are feeling increasingly disatisfied, which leaves patients dissatisfied and thereby affecting patient care.  Unfortunately, many of these decisions are not made by the people who ACTUALLY care for these patients. As physicians, we train for years, sacrifice a great deal and take all the risk in caring for patients. It’s time for us physicians to #takebackmedicine. 

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Natasha Sriraman MD

Dr. Sriraman, MD, MPH, FAAP, FABM, speaks around the country on various topics: breastfeeding, postpartum depression screening in pediatrics, narrative medicine/physician burnout, cultural competency/cultural differences in infant feeding and social determinants of health. She has specialized training in pediatric psychopharmacology. In addition to seeing patients, she is an associate professor of pediatrics at Eastern Virginia Medical School and teaches medical students and residents daily. She also holds a master's degree in public health from the University of Pittsburgh and has designed curriculum for public health training in pediatrics and breastfeeding training. She also serves as Adjunct Lecturer at the College of William & Mary where she teaches a class on health disparities.. Dr. Sriraman is frequently involved with legislative advocacy and has worked with the Governor's office on having May declared as Maternal Mental Health Month in Virginia. She has received numerous awards for her teaching and research. She has also received grants from Health Resources and Services Administration (HRSA), the American Academy of Pediatrics (AAP) and jointly from Williams & Mary College/Eastern Virginia Medical School. She has served on the board of National AAP-Section of Breastfeeding, and VA-AAP Chapter, and Postpartum Support Virginia. She is currently on the Board of Directors for Academy of Breastfeeding Medicine and The Eliza Hope Foundation. 

  3 comments for “Physicians Need to Stop Doing Clerical Work

  1. Steven Zeitzew
    May 8, 2019 at 1:55 pm

    Some of what you describe is a hardware problem. One can use a laptop while interviewing a patient, face the patient while touch typing, and maintain eye contact. Less looking away than taking notes on paper, and much less than using a workstation and facing the wall. Not all EMR software is designed badly, some is designed to make the physician’s job easier and better, instead of meeting administrative demands. After the patient encounter one can use voice recognition software, more efficient than a keyboard and the current version of Dragon works very well. Too bad that most of us work in places where we no longer control software and hardware purchases, and especially too bad that we are not even consulted on those purchases.
    – Sir Geon, of Bones

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  2. May 8, 2019 at 1:24 pm

    Declare independence–go third-party free. More and more doctors are doing it. See http://www.aapsonline.org/freedom

  3. Dana
    May 8, 2019 at 7:36 am

    Agree with your point but should probably have someone proof read before posting.

Comments are closed.