83 | Annie Talks Leah Down about Charting

Annie - Well, hey there, Leah.

Leah - Hey Annie. How are you?

Annie - Well, I'm good. I know you've been having some challenges around charting lately. What's going on lately?

Leah - Lately might not be the correct terminology. This is my cyclical kind of meltdown moment where I'm like, I suck at charting. There's got to be a better way. I'm going to start figuring out other methods, other strategies, and other automations. Da da da da da. Because like most health care workers, I hate charting so much and my brain extra hates charting. I think that's partly because I'm dyslexic and it just takes extra effort to put thoughts together. And I'm also like, I think coming to terms with like I'm a bit of a perfectionist, so I like it to be really, really good. I want anybody who looked at my chart to know everything, which is all constantly working against me and just caseloads and trying to be a good provider in my visits and finding the time to get charting done. I just keep going through this different iterations and yeah, I kind of like all came to a head last week where I was like, there's got to be a better way. What am I not doing that everybody else is magically figured out around charting. Luckily, a pediatrician friend of mine also reminded me that like, no, Leah, this is every health care workers plight is charting. So I feel like, you know, you've done so much research about all the ways and you're so good at finding systems. So I am complaining to you like show me a better way. Certainly there's a better way, right? Tell me there's hope that this won't be the plague of my life.

Annie - I mean, yes, it is what you signed up for. There is research showing that the charting aspect of things makes health care providers depressed and anxious. So it's not just you. It's all of us. Sometimes I feel like when it comes to questions about charting, it makes me flashback to when I was a new mom with a toddler who was very, very rambunctious and just loved to run. Any place we went to, she would be like, where is the farthest I can go in this room? I want to just climb those stairs. I don't want to sit down. And I always felt like I couldn't talk to other moms about it because they would be like, well, I just set the expectation that we sit and I'm like, but how do you do that? How do you at one time talk to my friend about like, I'm like and she pulled my hair. This is when she was like a little baby, maybe like eight months old. And my friend, I'll never forget, she had super long hair and she just tossed her hair back. And she was like, I've never had that problem with her two kids. And I'm like, okay. So clearly I have problems that nobody else has. And if I just figured out their system and their strategy, I would be more on top of this. Everything would make it look exactly. And then now I realize, watching my child grow up and she's wonderful and awesome and energetic and like this just who she is. And I was doing what was right for her by not making her sit down. Not that I ever could, like that was even an option that was not even an option. So like, people ask me questions about charting and I feel like there's this expectation because I create charting templates and I have an understanding of how technology works and that I have all the answers in that my charts are perfect. And I'm here to tell you that my charts are perfect. They are the most perfect charts, and I've literally never had a problem making them sorry.

Leah - So no advice.

Annie - No advice.

Leah - Just be as perfect as me and you'll be fine.

Annie - Exactly. I mean, it's just I've never had that problem. Okay, That's also not true. Charting is something where there is an aspect of it. I'm not going to lie. There's an aspect of charting that I find very satisfying. Like the reason I have all those checkboxes is because I like to check boxes. It feels good to check boxes. I also like that I'm using something that I made and that I was motivated to make these charting templates to make them for other people like so I mean, there's like part of it that I do have a brain that works differently when it comes to charting. So I will acknowledge that there are things about charting that come more easily to me. But I will tell you that something that comes up a lot is like charting efficiently.

Leah - I think that's the biggest piece of it because the way I have my charts set up, like pieces of it are very efficient and I can kind of knock those out really quickly. But there's other pieces that I feel are valuable. Maybe they aren't, but I like to write a summary and that takes a lot of time for me, but it also kind of helps my brain kind of put the whole consult in a good effective, and both for communicating that with the health care providers that I'm sending reports to, but also just for my own kind of like wrapping up the visit, I like to have that summary, like really breaking it down for my own brain. And I think it helps me be a better provider because that's something that I can read really quickly and get a whole overview before I go in for a follow up visit. It's just like a really nice quick thing. So I like all of it, but I'm just not efficient at it. And this is where I've tried like so many iterations of like, you know, in the visit, trying to do it in my car after the visit, trying to do it, trying to block, you know, a certain amount of time at the end of the day that I'm going to do all of them or in the morning I'm going to do all of the ones from the day. I'm like tried every iteration of trying to do it. And none of them seem to be. I guess I'm just like on this hamster wheel of keeping searching for like, this thing out there that is going to make it all so much easier. And and maybe I need to come to a bit of acceptance, like you're saying, like, it's just hard for everybody. But I would love any ideas or tips you have about being more efficient, because I think that's where I am struggling. Like if I could get it done really quickly and it really truly only took, you know, 10 or 15 minutes, that would be one thing. But it's not. It's taking me longer than that.

Annie - So I've given up on charting efficiently. So if you listen to back episodes of this podcast, you'll hear me flipping my hair and talking about how I do my charting in the consult. I get all my charting done before I leave, and I swear I used to be able to do this like I did used to be able to do this. So then Covid happened. I went virtual and I was still able to do it chart virtual visits while they were happening. And because it was like the windows are side by side, like it's all right there. It's like not easy. When I went back to in person, I think I was just so happy to be with the people again that I was like, I don't want to chart during the visit. Like, I want to be present with you. I want to like, if my energy to you. So I don't think in the however long it's been now since I went back to in-person visits, I can't think of a time where I finished a chart during a visit. So I'm doing them in my car, which also doesn't work because I don't always have like, okay, this is what happens is a very New York City specific thing. Why I can't chart in my car is that I have a parking spot and it's hot, so I can't sit in my car unless I turn it on so that I can, like not be boiling in my car while writing these charts. But as soon as you turn your car on, somebody pulls up and says, Are you leaving because they want your spot? Then I feel like a jerk. I'm like, well, I can't be like, no, I'm not leaving. Duh. Just wait. So then I'm like, okay, I can't start my car, so I have to save them all to the end of the day. And then if I do more than more than one, I do. I mean, especially if I do three, like my brain is mushed by the end of the day. So am just trying to jot down very quickly like XYZ. Just remember this. If you remember nothing else, remember this.

Leah - These are the things.

Annie - Yeah. To come back and do it when I get home and then I get home and I'm like, not very efficient. I'm like spending. I know a long time when I get home at the end of the day because I certainly can't wait till the next day. So I guess my answer to charting efficiently is that I let it eat into my personal time.

Leah - I am so happy to hear that. And also also just because I'm like, oh, this sounds so familiar to like what I do is like, I save it up. I do either take some audio notes or jot things down in the visit because like, everybody's mouth looks the same at the end of the day if you don't do that right. But same I get to the end of the day and I'm trying to work my overtired brain into doing these notes which are already feel like climbing a steep mountain to get them done anyway. And then you work that into my tired brain and then, you know, I have six people in my house. Like it's not a quiet, peaceful space to work and concentrate and focus. It's, you know, chaos. And everybody wants to know what's for dinner. That's like when you have four boys. Like that's the only communication I get whenever I get home. What's for dinner? Yeah.

Annie - Why is there nothing to eat here? I just filled the freezer with stuff from Trader Joe's. There are things here to eat. Let me finish my charting. But you know something that I've come up with? That is what works for me. Good enough is good enough. So, like, the. The whole thing of, like, I just want to get this over with. I've just decided that that's actually a probably pretty healthy thing to think is that don't try to say like and then the left pterygoid was, you know 20% tighter than the right one or I don't even. Know, like I'm like, you know what? I don't need to write these things down. There is a certain element of like, I want to remember enough so that when I see you again, I know it's important to me to remember what I'm telling you to do. You know what recommendations I made for you? Like, that's the most important thing that I need to remember to tell you everything. But in terms of like, what I'm observing, I don't personally find that much specificity to even be helpful. Nobody wants it. Like, no provider is going to look at that. Like the pediatricians aren't going to know what to do with it or care if I send it and if I'm referring to somebody as a body worker, they're going to do their own assessment. They don't mean it's helpful for them to know, but like they don't really need me to get that granular in their job. And so I just need to remember what do I need to remember for next time? What's important? What is the minimum that I need for insurance? And that's where all the checkboxes come in. But when it comes to writing narrative, it's just like I keep it so simple. I'm like, good enough is good enough. Maybe I'll get a B minus on my charting templates, and I'm totally fine with that.

Leah - Yeah, yeah. And I really working on trying to condense the writing. And then also I think templates are always so helpful, like things where it's kind of already written out, which I've again gone through many iterations. I think after 12 years it's like I just kind of go through this cycle of like, This is fine, I can work with this. And then like there has to be a change. And then when I hear exciting new things, like I, I get really excited because I'm like, Oh, is this going to be the answer to all my problems is going to be solved through. I have such hope for a really great AI system to come out that will just write that part out for me. Because what happens when I have interns come through and this is what also makes this cyclical in my fallout is because I'll have an intern come through and they do the charting and it's so wonderful to have somebody else be able to help me with the charting and then they'll be with me. You know, it might be six months or a year and it's so great and I love it. And I get like a charting vacation and then like reality hits again and I'm like, Oh dang, I have to write all this. That's fantastic.

Annie - I know I have the same thing. It's like having my interns do it. They do such a good job. They don't miss a thing. They are perfect because they're sitting there charting while I'm doing their only role. That's their only role, and I definitely miss them when they're gone. I'm like, Oh, why are these notes not as good as they used to be? Oh, it's because I'm doing them. I also see it like when somebody there who works in my practice, if she's seeing one of my clients or I'm like, Oh, I really didn't write down enough for her to be able to pick this up, but she'll be fine. She'll but I'm like, I could do better for her. So I have been trialing. There's a couple of solutions, these AI solutions out there, and I have tried one of them, the one that I've tried is called Nabla Copilot. And then there is another one and we'll put the link to both of them in the show notes. And I'm not going to remember the name while we're podcasting, but I will look it up and get it in the show notes. So you have two to look at. But basically the way Nabla Copilot works is you open your browser and you click start consultation and it listens to everything that's happening. And then when you're done, you hit end consultation and it turns all of that into a soap note. So you get the chief complaints, the history, you get the exam and you get the plan. And it does a really good job. It's been trained on lactation. So it knows the terminology, so you're getting the correct terminology. And so it's boiling down the entire visit into this summary. And that has helped me because then I'm like, those are the things I need. If I say it, it'll show up. It'll be there. If I say, I want you to do this, I want you to do these exercises. It's going to generate that in the note and then you can copy and paste it. So when it comes to like the plan part, like the way it's worded totally sounds like me so I'll just use that as a reminder. I'll put it in the treatment notes area and then I'll use it as like, okay, let me now let me just say this in my own words and the care plan, because that's really important to me and I probably wouldn't say it like that, but it'll give me enough to remember like, oh, because of this reason that I want to make sure to tell them again, like it triggers my memory enough for the important things and then it covers the bases. It's HIPAA compliant because there is no cloud sync. So what happens is if I do it on my iPad, I can't access that. Even if I sign in through my email address, I can't see on my computer what I've done on my iPad. And if I forget, if this has happened to me a few times when using it at the end of the visit, I'm so used to just shutting my iPad and leaving. But if. You don't hit, generate note and let it generate the note. You'll lose everything. You don't even have the transcript. So that's where it's like from a security standpoint. I'm like, I actually like that inconvenience because when something is listening to you, I don't want it recorded anywhere. I want it to be lost. Yeah, that.

Leah - Would be weird. Yeah.

Annie - I don't want it to exist on any server, even cloud based in my computer. That's a little too creepy. So, you know, I have complicated feelings about it.

Leah - Totally.

Annie - In my other professional life. I am participating. I'm a Writers Guild member, so I'm technically on strike from writing any Hollywood movies that come my way. Can't write them. Sorry, I have to say no. But the big reason that the writers and the actors are striking at the time that we're recording this, it's early August. The writers have been on strike for almost 100 days because they want to replace writers and actors with AI, and they've been using movies to train AI to write movies. And I don't like that. So like, yeah, it's a technology that I have very mixed feelings about. But in this setting, this health care application, I actually do really see the potential. It can't replace an intern. I still want interns. Yeah, but it's replacing me because I'm the weakest link in this whole starting situation.

Leah - Yeah, same. So definitely the same. Yeah. So I'll have a robot do it instead of me. Maybe someday the AI and the robots will be the thing that saves me from the not fun part of my job, which is all of this charting. And I really just commend. I have heard of these magic unicorns out there who do all their charting in the visit and they have it all done and wrapped up and tied up with a beautiful bow before they even walk out of the door. And I just like to commend you and I just love that your brain is doing that. And I am so glad that not everyone has to go through the suffering of charting that. Listen, struggle through.

Annie - If that's you, I totally believe you that you can do it. I know you can do it. I used to be able to do it. But you know what? I also used to be able to stand on point shoes and I certainly can't do that anymore. So I've been able to do all kinds of extraordinary things in my life that I can no longer do. And I'm okay with that. I don't need to recreate the glories of my youth charting. I know.

Leah - Our brains. Our brains were definitely different back in the day. You know, like I feel like I could multitask in a levels that I can nowhere get close to now. But I so appreciate you spending the time with me, Annie, to talk me down from yet another charting meltdown. But I'm going to accept what is I have to do these charts. I know that there's tools out there that I could look into about trying to get them to be a little bit easier, but I'm going to let go of the need to make it all perfect and that there's some magical thing out there that's going to change it all and just, you know, get through it, get it done, get my B minus and move on.

Annie - Get your B minus and move on.

Leah - And go make dinner.

Annie - No, go have somebody make dinner for you. You've been charting. Exactly. You're exhausted. Exactly. Well, this was fun. It helps me to talk about this stuff, too, because I'm always like having to think about my own expectations of myself, which are often quite high. And I still get the B minus, but I beat myself up over getting a B minus. I'm like, But I could have done better. And you know what? It doesn't matter. Nobody is grading me. Nobody's reading these charts but me. And sometimes the insurance company and I've never had them come back and been like, Why didn't you tell us about the sternum mastonoid? Why not? Why? Why don't I have the word condyles in here?

Leah - They’re never saying that.

Annie - Yeah, I just threw a bunch of words that I should know how to use in a chart. But you know what? I'm never going to. So it's all good. It's fine.

Leah - Yes, definitely. Well, thank you so much, Andy, and I'll look forward to our next conversation.

Annie - Always. And come to our deeper dive this month in September on September 22nd at 3 p.m. Eastern, 12 Pacific, we are having a deeper dive into trans mask and gender non-binary individuals and lactation with Laura Vladimirovich, who is a therapist and a IBCLC. She's also an amazing doula and birth photographer. She's going to walk us through the very specific considerations when working with this population, questions that they might be asking that you may have never even heard the question before, to let alone know how to answer it and how to help cultivate that collaborative experience for them when working with growing their families.

Annie - So we're excited about this. This is a topic that both Leah and I have very little. Variance with and obviously are not in this population ourselves. So excited to learn more. And Laura is just such a great person. I can't wait for everybody to meet her.

Leah - Yeah, I'm really looking forward to that deeper dive and really expanding my knowledge base around this so that I can continue to provide inclusive support.

Annie - Definitely. All right. Well, until next time.

Leah - See you soon. Bye..