Hello! Welcome back to The Friday Sign Out - a newsletter for primary care physicians and advanced practice providers.

Happy Friday! I hope everyone had a great week. We continue to soak up the summer vibes, and I’m trying not to count down to the start of school. My oldest is starting kindergarten, and not to sound cliche, I honestly cannot believe it. Time really does fly when you’re having fun (or when you are exhausted, sleep-deprived and surviving the ups and downs of parenthood 🙃)

We might check out the Ohio State Fair this weekend. Butter Cow, anyone?

Here’s what I’m reading and thinking about this week.

In the News

“NEAT” stands for non-exercise activity thermogenesis. In brief summary, this is all the calories a person burns throughout the day doing everything outside of deliberate exercise. Examples include taking the stairs, walking to the local coffee shop, strolling through the grocery, even folding laundry and cooking dinner. This article discusses the importance of NEAT in maintaining a healthy weight and metabolism.

This is great info for patients. I love the fact that just meandering through the grocery store can double your metabolic rate. Don’t discount the simple tasks!

In Your Practice

Today’s tip relates to prepping for a clinic day.

Look ahead, but not too far ahead.

Pre-charting is a bit of a buzz-word. Over the past several years, there has been a push towards pre-charting. Physicians are encouraged to spend time looking ahead, drafting notes, reviewing records, pending orders, etc for each patient prior to the office visit. I know many docs and providers who extensively pre-chart and this works well for them!

You do you. I am a bit on the other end of the spectrum personally. I usually don’t open the chart early - honestly, I wait until the patient arrives! I spend a few minutes (anywhere from 1-10 depending on the complexity) looking at previous notes and labs, reviewing hospital records, and pre-populating my note template before going into the room. Sometimes I prep a couple patients at a time, and then I can hop from one to another without going back to my desk - it just depends on the flow of clinic that day.

Back to my tip - I do think there is utility in looking ahead at your schedule. I could probably be better about this! A word of caution, though - looking too far ahead can be overwhelming and lead to wasted time. For example: you spend 45 minutes at the end of the day reviewing patient charts for 2 days in the future. Fast-forward 2 days: 1 of these patients doesn’t show up and since 48 hours has passed, you have to review the chart again to jog your memory before seeing the other patient. Wasted time!

Also, looking too far ahead sometimes makes me anxious. A day full of complex sick patients 5 days out? Don't stress about that earlier than necessary.

Do you pre-chart? How much? What works for you? I would love to know. Just reply to this email.

In Your Heart

James Clear (a Columbus native, for all my fellow Ohioans) is a writer and researcher focusing on habits, self-improvement. He is the author of Atomic Habits, a great book about the science of forming habits and making change in your life.

This quote brings to mind the concept of seasons in life. Some seasons are for leaning in, moving forward, and advancing while others are slower and more settled. I love James’ question - what is the current season asking of you? What do you need more of?

Have a wonderful weekend!

Ashley