Treading Water in a Sea of Paperwork

In the movie Stranger Than Fiction, Will Ferrell plays IRS agent Harold Crick.

In one scene, Harold Crick is filing papers in the biggest file room you’ve ever seen. He compares the sound of the file folders to the sound of ocean waves lapping on the shore. He is soothed by the woosh, woosh, woosh.

If only I were that nerdy. Don't get me wrong, I'm pretty nerdy. I like checking things off my many to-do lists. I like opening a brand new notebook or a blank Pages document on my Mac. I LOVE going to the office supply store. If I don’t have a reason to buy a new pack of sticky notes, I will make one up. BUT I’m not as nerdy as Harold Crick.

When I am faced with the impossible choice of catching up on paperwork or helping a living, breathing human being, I will choose helping. Hands down. When someone is suffering, paperwork does not feel fun or soothing. When I am exhausted, the last thing I want to do is organize a pile of papers, whether they are tangible or electronic. If Will Ferrell’s character was an olympic swimmer in a sea of paperwork, I can barely tread water.

In this blog post I offer no helpful advice about your overload of paperwork. Mostly, I want to acknowledge the behemoth that lurks over your shoulder as you attempt to provide quality patient care. The struggle is real.

In order to validate for you that the struggle is real, here are a few observations about the current state of paperwork in healthcare.

Paperwork takes time.

When did healing become a practice in paperwork? There are definitely things to take notes about: the last dose of medicine, symptoms, etc. But when the time it takes to fill out the proper forms eclipses the time spent with a patient, there must be something wrong.

Paperwork takes attention.

The weight of a thousand phone books* weighs on you not because your record keeping is just a bunch of notes. It weighs on you because people’s lives depend on your notes. In 6 months, when your patient ends up unconscious in the emergency room, your note about their drug allergies could save their life. It is equally likely that no one will ever read your note. (This last statement is my educated guess, not scientifically validated.)

*A phone book is a printed collection of all the phone numbers of every person who lives in a town. People mostly use these for doorstops now.

Paperwork is more important when turnover is high.

But then you have less time. I’m guessing you want to make thorough patient files. That way, when you’re not there, someone else can pick up where you left off. That way you don’t have to bear the burden of one client’s suffering alone. When there is appropriate time allotted for paperwork, you can paint a vivid picture of your client’s health situation. Then, the next person who reads your perfectly-constructed record can know what’s important for your patient. Likewise, when all your co-workers have finally had enough of the healthcare system and stage a mass early retirement, you will be able to depend on their notes when you’re treating the person in front of you. They don’t have internet access at their vacation homes in the South Pacific. What if the turnover problem could be solved by allotting sufficient time for paperwork? Maybe the South Pacific is a more reasonable dream.

Paperwork does not fit in the cracks.

It seems to me that employers are doing a very bad job estimating the amount of time it takes to actually complete necessary record keeping. Or maybe they don’t care. Paperwork is not billable. Paperwork is the method by which bills are created. You have to do the billable stuff in order to make the paper stuff. So healthcare professionals are often expected to squeeze paperwork into the cracks of time between patients. Where are these mythical cracks, anyway?

Paperwork does not play well with friends.

Think how amazing it would be if a patient only had to answer those health history questions once in a lifetime. At least things like birthdate and blood type for crying out loud. There are things that are not going to change. Then you could just update the rest. I don’t know about you, but as a patient, I cannot remember what I had for dinner yesterday let alone the entire timeline of my health history. I’m sure things are missing each time I have to start over. How amazing would it be if you, the new healthcare provider, didn’t have to start from scratch? So much time saved! Alas, we have managed to send spacecrafts into interstellar space, but we still can’t seem to adequately coordinate electronic medical records.

Paperwork is not paper.

Sometimes the technology we are given to make record keeping easier is, in fact, harder. As alluded to above, our electronic medical records do not travel with patients to all their providers. Sometimes we have outdated computer systems that should have been replaced after Y2K. Sometimes (eek!) the internet goes down. Sometimes we forget to hit the save button. Sometimes we are really slow typers. You can’t even make electronic records sound like waves lapping on the beach. Well, not easily. Paperwork has been reduced to a bunch of zeros and ones. Allegedly we have saved some trees, but I’m skeptical.

Paperwork is like the electric washing machine.

The washing machine was touted as the wife’s best friend. It was meant to take away all the back-breaking labor of manual laundry. It did take away some of the manual labor, but it added expectations. Instead of washing clothes after every few wears, women were expected to launder an item after every use. It also meant that men, children, and household employees stopped helping with the laundry. It turns out that the electric washing machine made it so that wives spent more time doing laundry than they had when it was a washboard and tub. Healthcare professionals no longer have giant file cabinets or have to carry around thick paper files, but my guess is that documentation expectations have increased (*cough cough* insurance companies).

Instead of a relaxing beach scene, the paperwork piles higher and higher. It is not neatly stacked. It makes no soothing noises (beep! beep!) and it leaves nasal paper cuts as it threatens to drown the entire profession. But wait! Let’s try to end on a positive note. None of this doomsday nonsense. Close your eyes, just for a minute. Lean back into that sea of paperwork and let it support you as you find whimsical shapes in the fluffy clouds overhead. Okay fine. Don't do that. It won't help.

Instead, try this: Go watch Stranger Than Fiction.

Harold Crick, who never takes vacation, is forced to take time off to deal with the voice in his head. It’s a feel-good movie that might give you some ideas about how you can work through burnout. If nothing else, you will be entertained.

And don't forget:

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#burnout #compassionfatigue #paperwork #willferrell #electronicmedicalrecords

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