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

Tomorrow is the first day of fall! Not quite sure how the time goes so fast, but here we are. Things have been feeling extra wild in clinic these past 2 weeks. Maybe it’s because it’s URI season or we are approaching that chaotic time of year after deductibles have been met. Either way, I come in most mornings wishing I ate more Wheaties 😆 

I’m looking forward to apple picking and lots of family time this weekend.

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

In the News

As recent as this month, 2 of my friends picked up poison ivy - not mild cases either! Also, neither of them have had it before. This article gives some background. Due to the effects of climate change, poison ivy is becoming more widespread and more potent. I’m sure we will see the effects in our practices. Stay tuned.

In Your Practice

Today, I’m sharing tips on charting and completing visit notes. I work diligently to finish all my notes during the work day. Here’s how I do it:

• I document the entire HPI in the room while talking to the patient.

• I aim to sign each note after each visit. Sometimes I will stay in the exam room and finish the note before hopping directly to the next room. I find if I return to my desk, I’m easily distracted (#coffee) and notes take longer.

• If I’m getting behind schedule, I allow myself to skip a note - but not more than 3 consecutively! This is KEY for me. If I’ve skipped 3, I force myself to take a few minutes and at least sign the next one. More than 3 in a row is a slippery slope. It’s easier to skip another and then another and fall disastrously behind.

• If notes are building up, I allow myself to get 10-15 minutes behind schedule to catch up.

• At lunch time, I finish any leftover notes from the morning (this is usually no more than 3). I do not go into the afternoon with any open notes from the morning.

• Finishing notes take priority over inbox management for the first 15-20 minutes of the lunch hour. The inbox is easier to do later with pockets of free time. By 3 pm, it is much harder to accurately remember what happened at the 9 am visit.

• I started using the Dragon dictation system last year and it helps immensely. I dictate the assessment and plan for each of my notes. I think of myself as a decently fast typer and Dragon is still more efficient.

TAKE AWAY:

If your goal is to keep up on notes, signing them must be one of your top priorities of the day.

If you’re curious, my others (outside of direct patient care) include answering phone messages, reviewing the previous day’s results, and addressing urgent MyChart messages.

I think “urgent MyChart” is an oxymoron lol.

I would love to hear any tips or hacks that help you finish your notes! Just reply to this email 🙂 

In Your Heart

It’s easy to feel overwhelmed by all of the duties that come with our roles as physicians and providers. I love how this quote gives simple guidance. If we can approach our days with this triple truth, we will do good work.

Have a wonderful weekend!

Ashley