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“What if it was absolutely possible to get that for yourself? And stepping you one step after another towards that goal.” -Dr. Sarah Smith

In today’s episode, Dr. Jen Barna has a very helpful and informative conversation with the Charting Coach, Dr. Sarah Smith. Do you struggle to get your charting done? Do you find yourself having to catch up on charting when you are at home? Do you wish you had more time that was yours instead of constantly thinking of all the work you have yet to finish? Do you want to make your work time be your work time and your home time be your home time and never the two shall meet? Dr. Sarah Smith is the Charting Coach for Physicians and a practicing Rural Family Physician in Alberta. Sarah is the founder of the Charting Champions Program, helping more than 150 physicians in the specific area of getting home with their charting done. Sarah has a passion for reducing burnout and overwhelm resulting from the administrative burden of clinical medicine, using evidence-based coaching to help Physicians find their most simple solutions within the clinical environments that they work in.

Sarah is a Physician Champion in her Primary Care Network and strives to build robust systems within her clinical environment.

Sarah is married to her husband of 21 years, and together they have two sons.  She lives on a small farm and spends her evenings and weekends enjoying pursuits such as farming, exploring, reading and coaching.

You can find out more about Sarah at www.chartingcoach.ca

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Podcast produced by: Amanda Taran

Enjoy the full transcript below

Sarah: What if it was absolutely possible to get that for yourself and stepping you one step after another towards that goal?

[DocWorking theme]

Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna, and today, I have a terrific guest, Dr. Sarah Smith. Dr. Smith is the Charting Coach for physicians and a Practicing Rural Family Physician in Alberta, Canada. Sarah is the founder of the Charting Champions Program helping more than 150 physicians in the specific area of getting home with their charting done. Sarah has a passion for reducing burnout and overwhelm resulting from the administrative burden of clinical medicine using evidence-based coaching to help physicians find their most simple solutions within the clinical environment that they work in. Dr. Sarah Smith, welcome to DocWorking: The Whole Physician Podcast.

Sarah: Well, thank you for having me.

Jen: Please tell me a little bit about your story, and how you came to appreciate efficiency, and what led you to develop a coaching program around charting efficiencies.

Sarah: Absolutely. I am a Family Physician trained in Australia initially and came to Canada eight years ago. So, I am a Rural Family Physician and still practicing mid-career. You could call me, I think, I’m 20 years on the job now. So, at about the 15-year mark, I thought, it should have been better than this. I was still in the office hours after the last patient left, and I really wanted to be home, and then, I knew when I got home, I would still have hours and hours of paperwork in charting left to do. It was impacting my ability to sleep, enjoy my family, and I really thought I should be better at this by now. At the time, I was looking for help, and really the physician coaches that I came across were all helping us leave medicine. When I asked my mentors, they were just saying, “Come in on Sundays,” and that was their answer to this paperwork and charting problem. Neither of those were what I wanted. I still really enjoyed my patients, but I really wasn’t enjoying the paperwork or charting.

I came across Life Coaching from a general life coach perspective. She said, “She could help me with any problem,” and I’m like, “But you don’t understand charting and paperwork.” Through the process of about 18 months of figuring out the efficiency charting, I was able to get home after the last patient left with everything done. That was a huge amount of time I got back. It created so much time and space for family, for relaxation, restoration weekends. I actually felt like, I could have this distinction between working time and not working time. So, in the process of that, I did want to go and give this back to my fellow physicians. This is such a gift to be able to create time and to be able to get work done within work hours. So, I did certify as a Life Coach, and started helping physicians from a broad range of backgrounds. 

Family physicians, of course, was where I started, because that’s what I knew. But then hospitalists would ask me to help them internal medicine, increasing range of specialists, emerged doctors. So, the process helped all of them. These foundational steps of how do we find your most simple solution for getting home with your charting done. So, now, I have a program where physicians can come in and get started immediately and get the help. They need to be able to get home with their most simple solution to their charting and paperwork. So, that’s a little bit of my background.

Jen: Terrific. Wow. What an interesting path to reach such a place of success. So, how did you actually sort out a system that works for you?

Sarah: Yeah, so, it was first understanding where I wanted to go, and I think that is what the interesting thing about coaching is. Because a lot of people may not have come into coaching for physicians yet. It is a newish industry. Engineers get coaches, and executive coaches may be a term that people are aware of. But physician coaches really is a new and exciting area. So, coaching is where you identify what you want. What you want, not what your coach wants. So, for me, if you were asking me, what I want for you, I would love you to go home with everything done. Of course, that would be amazing, but you may not have that goal for yourself. So, you come into a coaching program saying, “This is what I want to achieve.” 

Right now, it feels big, and scary, and impossible. Completely impossible to go from where I am now to getting home with everything done. There is no way that can happen is the general expectation of people as a coming into my world. But what coaching does is it helps you say, “Well, actually, my thought was possible. What if we could start to imagine what life would be like and why would we want to create that for ourselves? What’s that most amazing life going to look like when you are getting this success and result for yourself?” Once we have a destination in mind, then we can point you in the right direction. So, we can give you the tools and strategies to help you improve your efficiency. But it’s dependent on your environment, number of patients you’re seeing, staff that you’re working with, you may or may not have autonomy in your schedule. So, we’re not saying see less patients, or change your EMR, or get more staff. We have to work with the physician right where they’re at right now. That’s the fun bit is. 

I can hold belief for them that even when they’re saying, “My staffing issue is a problem, my EMR is a problem. I see too many patients, my patients are too complex, I have women patients, I have too many kid patients,” like all of that story about our world, even then, what if it was absolutely possible to get that for yourself. Stepping you one step after another towards that goal, and having the courage to get started, and fail and succeed, but not quitting on yourself. So, that is the role of that coaching piece is to say, “What do you want to create and how are we going to get you there in the most simple way?
They’re going to come up with obstacles and a whole lot of things are going to get in the way.

Jen: Tell me when you are working say, in your own practice, what are some of the changes that you implemented in order to go from being overwhelmed and taking home a ton of work every night to having a successful practice where you finish your work at a certain time of day earlier than you used to and go home with some extra time at the end of the day?

Sarah: Yeah. So, the actual foundational steps of the how to, is we start with the charting. So, we start with the piece of, “What are you doing right now in terms of your charting? What’s left after the consultation?” If you did want to get your charting done after every patient, which initially can feel so impossible, how and where would you do that? What would have to look different in order to be able to get your charting done after every patient? So, that was where I started was identifying, what am I doing in my charting, and what could I improve and optimize in that, so that we were aiming towards completing that encounter before we move to the next one, taking those initial steps.

Jen: As you do that through the day, are you actually changing the way that you interact with your patients in order to allow time for the charting within the same time block that you had before to spend with the patient? How do you balance those two?

Sarah: Yeah. So, that’s going to again be individual to the doctor, because some of them will dictate straight after, some of them will come in with a scribe already, some of them will be doing typing in the room. We just optimize what they’re doing already. So, it’s not a one strategy for everyone. This is going to be unique to you within the encounter. So, that is our step two. We start looking and evaluating the encounter. So, that’s the time you’re in the room with the patient. We’re starting to be really curious about the minutes and seconds in the room. Because as you start to be aware and understand, all of my time with a patient is so important. Every single minute and second counts. Now, you can start to identify, when do I leave the room, what is interrupting me, what am I looking for, what am I doing a thousand times a day that if I took a moment to figure it out, we could make that so much faster. So, that is all part of it as well.

Jen: That really makes sense, because then you’re starting to notice where you’re wasting time that may only be a few seconds, a minute, or two at a time, but cumulatively, it makes a huge difference.

Sarah: That’s right. Yeah, that real compounding effect on our day, we look specifically at interruptions and distractions, because each interruption is costing you another five decisions. Because you’re thinking about what am I doing right now, where are my at, how far behind am I, If I do that now, what will that cost me for later, can I do it now, or do I need to sit down and look at that chart? Can I give an answer quickly or do I need to go and look at that patient first? So, that’s a whole lot of decisions and when we’re looking at physicians and their decision fatigue. That’s compounding even more. 

We’re looking to figure out, what are our best solutions within your clinical environment to improve efficiency. Look at the time, look at the interruptions, look at the distractions. Distractions is a separate from interruptions. It’s where you could have external ones like when they’re building the car park outside the clinic and you can hear the jackhammers, and it can be the internal-driven distraction of, “I don’t like charting, charting’s painful, I despise it.” So, when I have to sit down and do my charting, I actually want go find anyone else to talk to, another cup of coffee, chocolate chip cookies like anything else.

Jen: That’s a really great point. So, how do you coach people through that type of distraction?

Sarah: Yeah. Distractions is just simply our human brain looking for pleasure. So, we all love pleasure, and we all hate pain, and we’ve often associated this charting as painful. So, part of that is identify why would you want to do this even though it’s uncomfortable? What is the gain you’re going to get from this? Many physicians who come into my world would identify as ADHD are procrastinators like professional procrastinators, they often call themselves. 

Even then, it is possible to start learning a new way of overcoming those distractions for yourself. So, we have guest coaches coming in, who specialize in ADHD, and help people with their efficiency and the initiation of getting their work done. So, we’re working on building a plan for what you’re going to do in the next however much time you’ve allocated for yourself, so that, it’s already prioritized for you. You’ve made that plan ahead of time so that when it comes time to do it, we have less hurdles to overcome in order to get started. We don’t sit at a desk and start looking around going, “Where do I start? There’s the inbox. There’s emails. There’s charting, I don’t know what to do first.” So, they pause.

Sarah: Mm-hmm. It sounds like, it’s a systematic approach of increasing efficiency by recognizing multiple points in your day that you’re repeating, then you could make them more efficient by removing the thought process of the decision tree for something you decide multiple times a day. You could just make a system that, “Every time I see this situation, I’m going to make this decision, and therefore, I don’t have to rethink the decision every single time.”

Sarah: Then recognizing when you’re just in that discomfort or restlessness, and understanding that nothing’s gone wrong, of course, your body is restless. Nothing’s gone wrong, of course, you want cookies, nothing’s gone wrong, of course, you want to go chat with another human. But you made this plan for yourself for a reason, and if you get this plan done now, what will that look like and how will you be looking after yourself at 4 PM versus I just wandered my way through the lunch break? Not doing very much at all, and now, I have another hour of work, and now I’m really annoyed myself in the evening.

Jen: Yeah, so, it’s helping someone to understand how to change their incentives in their minds, a very short-term way of giving yourself something to satisfy the discomfort of knowing what you have to do and seeing a little bit more long-term which may just be a couple hours away the benefits of making a different choice. 

Sarah: Absolutely. Yeah.

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Jen: Have you noticed any patterns among the different clients that you’ve worked with in terms of things that multiple people have seen success with, even though, everyone is an individual and has some differences in their plan? 

Sarah: Yeah, so, many of the physicians, no matter what environment they’re working in can start to see that it is possible to get that charting done after every patient. By keeping that protected clinical time within creating, so part of that consultation is starting to help you run closer to time and leading the consultation, so that you’re in charge of that time keeping within the consultation, then you’re closer to running on time that allows us to start to think about your other work of the day in bigger blocks or batched blocks, so, you’re not doing work twice or three times. So, we’re trying to help you with whatever you’re doing. If you’re seeing patients for an hour, because your neuro development pedes, but you’re in a team and you’re waiting for the team to finish their part of the note, your part can be done. Then, you may have another time of the day where you review the note and close it for them as the executive director in that situation. 

In hospitalists, even then, what can you get down into that note right now before you go into the next room. In family medicine, how can you start to be curious of seeing that patient during that note. So, even if they’re dictating, even if they’re typing, even if they’re using a scribe, we’re still working towards that same goal for them finding their most simple solution. So, I think that’s one of the biggest differences is, we moving through the day with less mental load. We’re not pushing those multiple encounters into our head trying to remember. I need to do that referral for Mary, and Mrs. Jones needed her mammogram, and all I forgot to do the MRI for Mrs. whatever. So, those pieces, we are eliminating by having our work done as we go. So, that is found across all of the specialties and all of the physicians working no matter what environment they find themselves.

Jen: Yeah, absolutely. That makes complete sense and I’m curious too, when you work with clients and also in your own personal life, when you’ve implemented this system and this is working for you to make your workday more efficient, do you find that it bleeds over into your personal life? Do you use a similar system there?

Sarah: So, all of the physicians in my world come in with a backlog and a whole lot of paperwork issues at home as well like, “What we do in one place we do in many places.” So, difficulty in submitting taxes, difficulty with getting their backlog done, often coming in with days, weeks, or months of charting uncomplete, and that is welcomed in our environments. We have a community of physicians, a community of your peers, and it’s the first safe place many physicians have found that they’re able to say, “I have a hundred unfinished charts,” and they’re thinking that’s desperately awful, but compared to some of the people in the group, they’re like, “You’ll be fine. We’ll have you licked in no time. No problem.” 

So, our module is intentional homework, because intentional homework could be submitting taxes, submitting CME, organizing your closet or doing your backlog. Yes, we are taking those principles of, let’s figure out what is your plan that you would love to create for yourself what would make your day or weekend more delightful or successful, and then let’s work on building both backlog time and not backlog time actually separating you from your work and giving you that ability to rest, guilt free. I think, it is so important when we’re dealing with burnout, and overwhelm physicians who feel like they can never turn work off.

Jen: Absolutely, and I love what you’re doing. But it’s very similar to what we’re doing with DocWorking Thrive in terms of the coaching support in addition to the community of peers, because I think that’s something that we so commonly feel as physicians, “We feel isolated and whatever the problem may be, whether it’s, I have hundred charts that I’m backlogged on, or my workload is really more than I personally feel like I can handle, but I don’t want to say anything, because maybe, I should be able to handle it or feeling like you can’t keep up at home, because you’re working so much that you’re exhausted and decision fatigue, at the end of the day, just trying to make really simple decisions at home.” All of those things, I think in our own minds can be blown up and seem overwhelming, and then when we get into a group of peers, where it’s a private safe space and we can talk, that’s similar in terms of the community that we’re creating with Thrive, and the community that you have, and you’re part of DocWorking Thrive. So, you know about that. 

The idea is that, once we start to voice those feelings in a safe space and find out, “Oh, gosh, other people have the same problem,” or maybe even, other people are like, “Wow, really you only have a hundred charts backed up?” [laughs] So, then it’s like, “Oh, well, maybe it’s not as bad as I thought.” It’s the isolation I think that really can compound the stress that leads to burnout, and so, hopefully that peer type of support in addition to the coaching support can make a big difference for people.

Sarah: Yeah, another trend I’ve been seeing recently is often workplaces is trying to find ways to punish the physicians who aren’t closing their target same day, so that might be financial, or adding extra workload to their day, or punishing them, that open shaming with the emails that are named. So, having come from that pain or the financial disadvantage to the physicians are now under earning whether it be because of being financially punished for not having charts closed or losing money because they’re not billing as they go out billing within the time period allowed to them. That’s another driving force for why they want to start making this change. So, it’s not just them in their discomfort and shame of not having the charts, and now, there’s actual implications for their family or their work life as well.

Jen: Yes, and hopefully, by encouraging that type of community and peer support, we can as physicians facilitate changes, so that there’s less and less of that type of punishment, which is completely absurd, and certainly, contributes to burnout and driving physicians away from practicing. So, finding ways to be more efficient is one part of it, and peer support in terms of coping with those types of environments is another important factor coaching and peer support for that. But I have been in that type of scenario, and I’m sure most of us have in terms of first practice that I was ever in as an employee of the hospital, the hospital administration used to send out monthly to all the physicians who were employed, they would send out a little print out that had, how you were doing in comparison to the national statistics for someone in your specialty in terms of the volume of cases that you were reading. 

But then there was no acknowledgement of the inefficiencies that were built into the system where we practice, and that might affect our practice versus a streamlined group of 50 specialists who have everything worked out to be as efficient as possible. So, it is certainly a sign of the times, if you’re a physician who is dealing with that type of scenario.

Sarah: Yeah, it’s just another opportunity for physicians to feel overwhelmed or burnt out. But helping them understand that, “Hey, this doesn’t have to be the way, you don’t have to have that experience that your working life is overwhelming, or that you don’t know where to start, or you don’t know how it’s all going to get done.” Because those feelings are quite painful, and they’re not helping you. When you’re going home to rest and restore, those feelings come with you, and you just never feel like you can be separated from work. And just understanding that, “Hey, what if it was possible to have a clinical day that you’ve designed for yourself even in the environment that you work?” And there’s some intention about it, you’re starting to evaluate it and take that true leadership role for yourself in evaluating what do I want for my day? How would I design this for myself if I was to have thought about it, and not just being in that business of day after day the same, starting to be curious about how else could I do business, how else could I have rearranged to this for myself, so, I can be getting home, I can be enjoying my day, I can feel like I have joy back in my clinical day.

Jen: I’d love that. I think, that’s fabulous. By doing that, you also feel empowered to realize, now, I’ve done what I can do, and this is as efficient as it can be as I can make it, and it’s also okay to set some boundaries, because at that point, you have the confidence of realizing, “I’m doing this, well, I’ve made this efficient, and I’ve made the improvements I can make. Now, here’s a reasonable amount of what I can do,” and you can take it from there in terms of whether that’s sending you home at a reasonable time or whether you need to make some changes, but I think it’s empowering to be in that position. So, I think it’s fantastic what you’re doing, and I’m very pleased to get to hear about it, and I really appreciate you coming on to talk with me. 

Sarah: Oh, it’s been my absolute pleasure. Thank you so much.

Jen: Thank you. I look forward to talking with you, again. We’ll definitely have to have some conversations in Facebook Live format within the DocWorking Thrive Private Facebook community.

Sarah: Sounds great. Thank you so much.

[DocWorking theme]

Amanda: This is Amanda Taran. I’m the producer of DocWorking: The Whole Physician Podcast. Please don’t forget to like, and subscribe, and thank you for listening.

 

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