Keeping it simple with paper charts
I enjoy using the paper chart system in my primary care practice. I can see why doctors may have been resistant to the forced transition to electronic medical records (EMR), even to the point of retiring earlier than planned to avoid the change.
My entire training had consisted of using the EMR, until I started working at a private practice primary care clinic as an attending. At first it was difficult to get every patient right using the paper charts. Nothing was searchable and the previous doctor’s notes were minimal and illegible. I quickly developed my own system though, and now I’m surprised at how well it works.
Charting is not a big part of my day. I still hear of colleagues finishing up their notes at home after-hours. That’s never the case for me. My notes are succinct. I believe there is a difference in how the mind works when typing versus writing by hand. One obvious difference is that when typing, I tend to write more. That doesn’t mean it’s better, just more letters and words. Writing by hand forces me to slow down and be choosey with what I write, because writing each letter is cumbersome. And importantly, despite relatively less documentation I never felt patient care at follow up was compromised.
It makes me wonder how simple it must have been to start a practice back in the day. I heard it was the norm where doctors finish residency and start their practice the very next day. Internal medicine especially doesn’t require all that much: simple diagnostic equipment like a stethoscope and EKG machine, a phone, a fax machine, and pen and paper. Once it starts getting busy an assistant may be helpful.
Now our clinic has a computer:employee ratio greater than one, an EMR with expensive monthly fees that still doesn’t work well, and over 6-7 staff members for every physician working. Overhead costs continue to balloon.
The paper chart for me was a reminder that when it comes to taking care of a patient, not much is required. My clinical knowledge, and a pen and paper. That’s it.