I had a colleague once, when I was working at a residency, who gave what I thought was great advice to the residents with regard to the EMR: “Write a crappy note now, or a crappier note later.”

Now, I know this is not what you want to hear, but truthfully, is your note going to get better for having been left open for a day (a week, a month?)

I learned this lesson the hard way. One day I saw 22 patients. During the day I did 2 well women physicals. Although each woman was blonde, in her 40’s, with unremarkable vital signs and health history. One woman had a normal pelvic exam, one didn’t.

When I went to complete my charts that night, I wasn’t sure which woman had the abnormal pelvic exam. Luckily, I wrote the orders on a separate sheet, which I was able to find. Once I saw the orders, it all came back to me. I was able to complete my notes and keep it all straight.

But what if I’d waited a week? Or two? It had happened in the past, although I told myself I put enough detail in each chart at the time of the visit to make the documentation “easy” to complete.

The length of time the visit takes includes the time it takes you to document the visit completely.

A friend of mine used to run on time more than his partners did. So the staff put any add-ons in his schedule. He ended up seeing many more patients than his colleagues, despite the fact that they all got equal pay. And then my friend would have 25 or 27 charts to do at the end of the day. He started documenting all of his charts in real time. If he got busy and had three unfinished charts on his desk, he didn’t go see his next patient until he completed the three charts. At the end of the day, he never had more than three charts to document.

I tried doing things this way but I found that even one open chart felt overwhelming and I would start thinking, I’m behind, what’s the point of trying to catch up? and one open chart would turn into five, then ten.

So I started doing my charts in “real time.” I would do as much as I could in the room with the patient, and then finish the documentation back in my office. It wasn’t easy to stick with it, but the decrease in my stress level was immediate, and I didn’t want to go back to that sickening feeling of never being caught up.

My recommendation: Start with one chart. Commit to completing the first chart of the day before you go see the next patient. Then, after that feels comfortable, try adding another chart, maybe at the end of the day. Keep going!

Let me know how it goes.