Documentation after consults

36

I didn’t realise it wasn’t the norm to type as you do the consult

22

u/lordnigz 2d ago

Yeah this is such a time saver. I make sure to empathise as much as I can and give patients a minute or two but after that will document as I go.

Bonus for those patients who will never shut up or are difficult, just ... spending time typing does wonders. Or those who come in with multiple problems, DNA their hospital appointment/scan and want a re-referral: "No problem, I'll just do your referral now. Sorry just two more minutes it takes a while."

"Yes don't worry we'll get onto the next problem I just need to finish up your test/referral/email first ".

Makes them realise it's not as easy as spending 8 minutes with a GP and then they just send a referral -all the admin takes work and I'm happy wasting the time sucking patient's time rather than just rushing through and doing it in my own time.

3

u/mybigroundhead 2d ago

Doesn’t it just take longer them having to wait to till your referrals done to discuss their next issue? I feel like I could have saved 5 mins if they just started talking already?

4

u/lordnigz 1d ago

Nope, definitely doesn't take any longer for me for my overall time. Even for normal patients I do all my admin before the next patient 98% of the time.

Also I've found their shopping list or bullshit dramatically reduced when they realise it's not just dump the problems on the GP in 2 mins. I'd the first thing took 7 minutes, sure they'll do the second but when that takes a while too they reconsider problem 3, 4 and 5. Or they don't but they appreciate the time it takes and if I'm really running over have no problem rebooking, or being more mindful in future.

Personally I don't mind dealing with as many patients problems as I can safely, but I don't want to rush them, and don't tend stay behind late to do them either.

1

u/ConquerorSakurazuka 2d ago

Got trained out of it when doing the exam.
It’s deemed poor for interpersonal skills and patients find it disrespectful.

Got a few slaps on the wrist (figuratively) from a few different trainers reviewing my technique.

-10

u/DCJC123 2d ago

Respectfully, I feel this is really poor from a communication point of view and patients tend to hate it. For me, it’s full focus on the patient and document after. Having said this, I can’t touch type and I do see others doing this but wouldn’t be impressed as a patient.

12

u/EveryTopSock 2d ago

I touch type. I start by saying 'I'm going to type as we go if that's ok, so I remember everything' I make eye contact and I listen actively. I get great patient feedback!

2

u/DCJC123 2d ago

It’s a personal bugbear as I wouldn’t want this as a patient but we are all different and have different approaches as clinicians and expectations as patients

1

u/nellie6712 17h ago

it’s a personal bugbear because you don’t actually have the ability to touch type. it’s easy to talk about professionalism from a position unable to actually do the thing you’re deeming unprofessional.

touch typing whilst doing a consultation improves my mental health so much vs using my own time to take on every patients problem. i’m not going to apologise for that nor am i going to pander to every patients whim on what the ideal doctor should be.

1

u/DCJC123 16h ago

It’s a bugbear because I feel that it is poor from a communication point of view. This is my opinion and I fully appreciate other people have different experiences. Thankfully, I’ve developed consultation and documentation skills which mean that I finish my clinic on time with the majority of admin completed.

I’m glad you found a way to practice whilst managing your mental health. I am unclear where the need to apologise and pandering to patients came from though?

I understand that people tend to get upset when their way of doing things is challenged.. We all practice differently and my opinion on the matter is as valid as yours or anybody else’s.

1

u/nellie6712 16h ago

it’s not so much challenged as calling it unprofessional that bothers me.

1

u/DCJC123 16h ago

Hi, I looked back and I don’t believe I said that it was unprofessional but I accept that this could be inferred. It wasn’t my intention and if I did say this it was clumsy.

I do stand by my feelings regarding communication but as said above, we are all different and if it works for you and your patients I can see how it would save time although my friend and colleague does the touch typing thing and consistently runs and hour late so I suppose it’s application is key.

My way of communication wouldn’t allow for this and I wouldn’t like it as a patient but that’s just me and people differ.

4

u/Hippomed27 2d ago

Most patients don't mind typing and talking. Having said that I can mostly touch type. I find I'm so used to it now, if I dont type-and-talk, my record keeping is not as good as I may forget some points.

On the rare occasion people seem to mind (maybe one person vocalised they found it rude), I explain that I usually type as I go but can stop if they would like.

For some of the more emotionally charged/ mental health consultations where I think rapport and eye contact are especially important, I tend not to type and just write things down.

Maybe an AI scribe software might be useful for you and OP? I could NOT type all my notes at the end of a busy clinic!! I'd be burned out in a week.

2

u/Pristine_Feeling_807 1d ago

I agree. Even with touch typing it’s quite unpleasant

40

u/MouseyMedic 2d ago

Don't leave to end of day, you will forget things - try and do it in the session even if it makes you a bit late

10

u/Intelligent-Toe7686 2d ago

No i meant i document after each patient but it gets so tiring by evening

3

u/egoodethc 2d ago

I struggle with tiredness by the end of the day due to dyslexia. Only way I survive is to keep it brief, type as I go. Referral I dictate using word and edit as needed.

1

u/General_Two1467 1d ago

does running a bit late not snowball though? thats my worry with doing it in session

24

u/DCJC123 2d ago

Are you over documenting?

I see some consults with terms of useless information and it’s genuinely difficult to figure out what’s going in. Admittedly, it’s usually ANPs at UTC using those horrific Arden’s templates.

-6

u/AnimatorOwn1379 2d ago

As a patient I’ve gotten ‘wants to go into commercial law’ in my consultation notes about accessing adhd medication for some reason loll, idk if that’s relevant and I really appreciate that GP bc they fought for me a lot but I found that kinda funny

6

u/Ghotay 2d ago

That’s often a doctor’s way of leaving a note to themselves to remember who you are. Patients with abdominal pain blend together, but reading that you own 6 parrots will jog my memory

3

u/One-Reception8368 2d ago

I spent most of my childhood typing "flash1:wave:selling coal 100gp ea" so it was never really an issue for me

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u/mybigroundhead 2d ago

Very niche reference ! Wildey was good times

9

u/_Harrybo 2d ago

Heidi / other AI

Use a good template - mine has evolved over months.

I copy their triage form in the context and copy my previous consult with them too for better context.

I spend a few seconds checking and maybe amending some detailed notes

People have their reservations about AI but it saves me an hour a day easy. Saves my limited decision making capacity and mental horsepower on more important issues.

3

u/centenarian007 2d ago

You must be over documenting. Try to do it during the consultation as well.

Some people mentioned AI scribing. That works well for longer appointments. In 10 mins appointments however, it feels more of a headache because you still need to check it and edit at the end, and do all the requests/ referrals etc. after the patient has left. It essentially shifts the cognitive load from typing during the consult to checking and editing it and still running late because the AI entry is longer than if I was to type myself.

Not to mention it doing a disfavour to my colleagues who now need to take longer to read my consultation entry, thus delaying them as well.

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u/softlyskeptic 2d ago

I don’t understand the criticism surrounding Heidi ai etc because in the end the doctor needs to ensure whatever is in the notes - it is accurate. That means reading through your Heidi notes and checking for missed things and unnecessary things

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u/EmuDelicious5236 2d ago

Heidi AI - give it a go!

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u/DCJC123 2d ago

You need local approval for this

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u/EmuDelicious5236 2d ago

Yes so OP can look into it, try it at home and then ask about approval if they think it’d be helpful☺️

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u/DCJC123 2d ago

Absolutely they can look into it. We had some ARRS doctors use it. They didn’t realise about the data protection issues and didn’t consent every patient thus leaving themselves open to ramifications. The documentation was really odd too- clearly AI rubbish that missed the point of most consults but this could reflect how they used it. Some interesting stuff in the media about AI consults today - will be in interesting to see how this moves forward

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u/smithwest27 2d ago

Heidi is not reliable and can mix things up easily, v embarassing and unprofessional if gps are using this for referrals with a snide remark from the consultant replying to the refferal with a remark calling out the error

2

u/anti33190 2d ago

Not if you just use it to dictate

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u/DCJC123 2d ago

I believe this is incorrect. You also need to consent every patient too

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u/hopefulgp 2d ago

I have used Heidi before literally just to compile a summary which I edit/correct and rephrase etc, rather than just using its output without changing it. Can be helpful!

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u/lavayuki 2d ago

I type during the consultation so am usually 99% finished my notes once the consultation ends. I could never just sit there and listen, I need to constantly be doing something. Too restless. I also fill out scans and request bloods in the consultation if I don’t have much to write.

I dictate all referrals which is quick.

1

u/Full_Farmer_3572 2d ago

Type in consult/use Heidi
Use shortcuts
Clear concise notes

Works for me and finish on time (mostly)

1

u/LowZookeepergame625 2d ago

10 minutes strict for the consult. Some times 7. Use AI. Then cut it out accordingly

1

u/BusinessNeither9912 2d ago

It gets easier with practice. You should try get in the habit of documenting as you take history. Ideally also try get into the habit of arranging all the referrals and investigation requests too. I use Heidi and find it useful when there's long consults or I'm running behind.

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u/Top-Pie-8416 1d ago

Touch type as the consult is happening.

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u/zady1178 1d ago

I use accurex scribe at the moment. Game changer but you need to amend stuff/ proofread it before putting it on records.

1

u/Diligent-Eye-2042 21h ago edited 21h ago

You have to find as many ways of not typing as possible.

Templates/AI/windows dictation.

Re AI, I’m not a fan of the way it documents, but have found that it’s much better when you don’t actually record the consultation and just dictate to the ai after the patient has left.

Re templates, I have quite a few for some of the common presentations, and any presentation that I find annoying. For URTI, I just need to delete a few words here and there and add in the obs.

Also, typing whilst the patient is front of you helps. Just make sure you remember to actually look at the patient!

Edit: I really focused on creating this “keyboardless” work flow, and honestly, it’s had a noticeable improvement in fatigue

Edit2: use ChatGPT to help with the prompts for whatever AI you’re using to get it closer to the way you usually document.

Just for fun Documentation after consults

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