Paperwork for many doctors has become overwhelming. While initiatives have tried to convert paperwork into electronic paperwork, are the new systems actually designed to make doctors’ lives easier? 

Alan: If I did not have personal knowledgte of physicians who confided this very problem I would have considered it gross overstatement. 

When friend HC, a children's haematologist at UNC Hospitals, was approaching retirement nearly ten years ago, he told me that approximately half his work day was spent hassling with insurance companies... in addition to the full-time person he had recently hired to undertake patient advocacy.

To the extent that "death panels" exists, they have been established by profiteers in the health insurance industry.

Doctors Wasting Over Two-Thirds Of Their Time Doing Paperwork

Bruce Y. Lee

Forbes Magazine

If medical school curricula were based on what a recent study says many doctors actually do with their time, more than half of medical school would be on how to do paperwork. Medical school admissions essays would be on “why I really want to do paperwork when I grow up.” Required classes would be “Introduction to Filling Out Forms” and “Advanced Form-filling.” Indeed, a recently published study in the Annals of Internal Medicine found that for every hour physicians were seeing patients, they were spending nearly two additional hours on paperwork. Is this really the best use of doctors’ training and ability? Isn’t this like telling LeBron James to spend the majority of his time manning the Cleveland Cavaliers ticket windows and phone lines? And isn’t this also wasting the time of patients, who came for the doctor’s medical expertise, not paperwork expertise?

The study confirmed what many physicians have already observed (such as James Sanders, MD in this 2005 editorial for Family Practice Management): the amount of paperwork that doctors have to do is out of control. Led by Christine Sinsky, MD, at the American Medical Association, the study followed 57 U.S. physicians in family medicine, internal medicine, cardiology and orthopedics for a total of 430 hours. In addition, 21 physicians completed after-hours diaries. The results? Physicians spent 27% of their time in their offices seeing patients and 49.2% of their time doing paperwork, which includes using the electric health record (EHR) system. Even when the doctors were in the examination room with patients, they were spending only 52.9% of the time talking to or examining the patients and 37.0% doing…you guessed it… paperwork. Moreover, the doctors who completed the after-hours diaries indicated that they were spending one to two hours each night doing — drum roll please — paperwork (or the EHR).

These numbers show that the amount of paperwork may be getting worse over time. Previous estimates such as from this 2005 study in Annals of Family Medicine were that paperwork consumed a third of physicians’ time. Thus, in a decade, paperwork has gone from being a large chunk to a majority of a doctor’s time. Nice progress.

Such paperwork is about as intellectually stimulating as shoving a stethoscope up your nose. It is painful, doesn’t take much ability to do, and makes you ask: why, why, why?

Tune in the next epidisode of the ABC Network drama series, “Grey’s Anatomy,” when Dr. Meredith Grey, (played by Ellen Pompeo) does paperwork. (Photo by Amy Sussman/Invision/AP)

The reason for the overwhelming paperwork is four-fold. First, there are now so many people involved in a doctor’s practice beyond the doctor himself or herself. You know those movies in which a person is trying to make a decision and there is an angel or a devil sitting on his or her shoulder offering suggestions and commentary? Well, add several dozen or hundred such angels and devils on her shoulders and you’ve got medical practice today. You’ve got people in administration, lawyers, insurance companies, etc., etc., all asking for information, which just produces more paperwork. And paperwork can be like the Octomom, leading to more and more paperwork.

Secondly, doctors are not designing much of the paperwork. 

Therefore, whoever is designing and requiring the paperwork has little clue on how to make doctors’ lives easier. You can’t design something well that you don’t use yourself. This would be equivalent to Lady Gaga designing NFL football uniforms. (Oh-oh-oh-oh-oh! Oh-oh-oh-oh-oh-oh! Caught in a bad pair of pants). Platform shoes and dresses made out of meat just wouldn’t work on the Dallas Cowboys and Los Angeles Rams.

The third problem is that many doctors are not getting any help to do the paperwork. Hospitals and clinics do not seem to be investing in clerical and administrative support for doctors. Some current regulations may be preventing others from helping physicians, such as those that require a physician to be the person entering orders into a computer. In a clinic in which I used to work, the way to complain about paperwork was to fill out more paperwork. This is like saying if your head hurts hit it with a brick until it stops hurting.

Fourth of all, the system is not changing to accommodate doctors. How much investment is there in finding and implementing ways to improve clinic operations and the workflow and lives of physicians? How much funding is going towards such research? There doesn’t seem to be too many avenues to get such funding — unless I am missing some forms that need to be completed.

As a result of the growing mass of paperwork with no change in sight, many doctors do not have time to do things most useful to their patients, society and frankly the clinics and hospitals at which they work. Do physicians have time to counsel their patients on weight management, opioid use, mental health, surgical questions and complications and a host of other things that patients want and need? Are physicians prescribing too many antibiotics, opiods and unnecessary medications because they don’t have time to carefully examine the patients and consider other options? Is excessive paperwork leading to physician burnout and dissatisfaction? Indeed, a study in the Mayo Clinic Proceedings from two months ago in July had surveyed physicians from all specialties from across the U.S. and found that many were dissatisfied with having to use EHR’s and this led to frustration and burnout. Here’s one doctor’s take on paperwork and burnout:

Studies have shown that physician dissatisfaction affects patient care and thus patient satisfaction. For instance, a study in the Journal of General Internal Medicine of 11 general internal medicine practices in the greater-Boston area demonstrated that patients of more satisfied physicians also were more satisfied with their health care.  Makes sense. Just like you don’t want to have a pissed-off chef, lawyer or airplane pilot.

Something has to change. Hire people to help with paperwork, develop better technology to complete the paperwork, give physicians more time to see fewer patients or get rid of paperwork. Despite concerns having been raised, what is really being done? There needs to be real action. Otherwise, doctors will just have less and less time to actually examine and treat patients. And this will hurt everyone and eventually the entire system will hit a breaking point. After all, no patient wants to hear the following words in a waiting room, “the doctor will see your paperwork now.”

Follow me on Twitter @bruce_y_lee and visit our Global Obesity Prevention Center (GOPC). Read my other Forbes pieces here.