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What is your charting nightmare?

based on a true story

I haven’t seen it all when it comes to time management and charting - but I sure have seen a lot. As I always say, if there is one thing that unites all clinicians, it is charting.

I have worked with colleagues and coaching clients who have really struggled with the demands of charting, and I have seen a variety of coping strategies. And I have seen some negative outcomes when it comes to the demands of charting - the worst was someone losing their job because they were so behind on their charting. I have to think this is just about the worst possible outcome; the only way it could be much worse would be to lose your license entirely. Imagine losing your ability to work in the profession that you sacrificed so much for, because you had too many charts open for too long.

What would be worse than losing your job because you had too many charts open?

Applying for licensure in a new state and having conditions placed on your license because of it.

Based on a true story: I know a clinician who was asked to resign because there were too many charts open for too long. I’m not talking about 10 or 20 or even 30 open charts; I’m talking hundreds. Of course that’s an issue, on so many levels; first and foremost, from the perspective of patient safety. If anything were to happen with these patients - like a trip to the ED - and their records were severely out of date, that’s going to potentially compromise patient care, could cause unnecessary delays in their treatment.

Then there is the question of how well these patients could possibly be managed if their documentation was so far from current. What was discussed in the last visit? What was the plan moving forward? Where do things stand with their chronic condition(s)? How can we know if their current state of health, as they appear before us right now, is their baseline or represents and improvement or decompensation?

From the financial perspective, it represents a huge hold on revenue. Signed notes are currency in medicine, and reimbursement for that visit can not happen until that note is signed and submitted to the payer (and even then, it takes weeks to months to receive the reimbursement). Likewise, it’s not unusual to have some limits in place about how long after the visit a note and bill can be submitted for reimbursement; I would not hold my breath if I was submitting for something six months after the fact.

From the perspective of the employer, asking for the clinician’s resignation solved the problem. (It did nothing to address the upstream factors that allowed such a problem to exist, and persist, in the first place - but if they were super concerned about that, I suspect they wouldn’t have let it get so bad.) But it did nothing for the clinician who was struggling with the charting; at best, it deferred the problem to the next employer.

When the clinician moved onto the next position in another state, an application for licensure was put in. It was approved - conditionally. Because the clinician had resigned the previous position, and because the reason was the significant backlog of charts, a conditional license was approved. For TWO YEARS, this clinician had to have their practice monitored - daily - by a third party to ensure that all charts were closed within 48 hours. If more than a small threshold of patients were to be seen each day (say, 10 per day), a scribe was to be put in place to help with the charting.

For two years.

And this was publicly listed along with the license information - even beyond the end of the two year window. I don’t know who paid for the person who was monitoring the clinician to be sure that charts were completed, but I do feel confident in assuming they were being paid.

Why do I mention this?

Because charting unites us all.

Have you ever been behind in your charting? Of course you have, we all have. Have you ever thought that you might suffer some kind of penalty (including public humiliation, as in this case) because of it? Have you ever had benefits denied to you because of it? Have you ever had your job threatened because of it?

And on the flipside, have you ever been taught how to chart? How to be efficient and effective? Or have you, more likely, learned the hard way - through trial and error, through reprimand and negative feedback?

Of course I want to help you learn to chart. I am good at it, and I have a passion for helping others with their charting. :) But more than anything, I want us - CLINICIANS - to have opportunities to learn how to do this essential task in a way that is constructive, empowering, realistic.

I don’t want any of us to continue to struggle, with no lifeline from our employers - just a demand to do more, do it better, do it faster, do it without instruction or any kind of guidance. Just do it. Or risk losing your job, your livelihood, your identity - and having a mountain of salt rubbed into the wound the next time the issue comes up.

Take care,


Here’s my quick thought about scheduling on a Friday afternoon…

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