In this episode of “DPC Pediatrician,” Dr. Phil Boucher and Dr. Marina Capella discuss one of the most significant pain points for pediatricians: charting. They share practical strategies to reduce the time spent on charting without compromising patient care.
By leveraging technology, optimizing workflows, and adopting best practices, they provide actionable tips to help pediatricians in Direct Primary Care (DPC) create more time for patient interactions and personal well-being.
Link to podcast: Efficient Charting Strategies for DPC Pediatricians
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you. Hey everyone, today we are talking about charting and charting is a huge nightmare for physicians
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and this podcast episode is called Can I Spend Less Time Charting in Pediatric DPC? And the answer is yes. And we can just leave it right there and close out the episode. No, I’m kidding. We’ll talk through it in more depth, but you can absolutely spend less time charting.
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I think that the vast majority of people that I talk to at least don’t chart after work at all. And so there’s light at the end of the tunnel. If you feel like all you do is work and run from room to room to room,
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and then you go home and you spend some time with your kids thinking about how much charting you have to do. And then you put your kids to bed and then you chart, chart, chart, and just eat up your weekends and your life just slips away. There’s hope. Then there’s light.
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And so my thoughts on charting, one is I hate charting. And I don’t feel like it helps me to be a better physician or take better care of patients to chart. And so it makes it really hard for me to do that.
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And Marina will tell you that I am terrible at things that I don’t like to do or don’t want to do. And so charting in pediatric TPC is so much more fulfilling because it is simply a Making sure that I know what I did in my last visit and making sure from a medical
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legal standpoint that I covered my bases. There’s no adding extra reviews of systems to meet the points criteria. There’s no over-documenting to make sure it meets the 99214 criteria. or all of the other note bloat that exists and creates for these really long notes
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and 15 extra clicks and searching through to find a specific code and all of the different things that make life miserable when you could instead be relaxing or spending time with your family or taking care of yourself that you are doing as a pediatrician in a fee-for-service practice that requires you to spend hours and
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hours per day charting. You don’t have to do any of that. It feels sometimes like the good old days, like you would see people’s clipboards or their notes where they like circled right ear infection, amoxicillin, and then they turned in their note. I mean, that communicates that in January, they had a right ear infection.
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And a lot of it too, you can template in there. Like they’re not toxic appearing. They’re breathing easily. And they have a right ear infection and amoxicillin, sign. There isn’t all of this. We have to over-document everything. To make sure that we meet all of these criteria.
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And so my experience with it is that I still get behind in my notes, but it takes much less time to catch up. And the notes are really for me and from a medical legal standpoint, they’re not to satisfy insurance requirements. And so it’s much easier to say,
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I’m going to be able to pass along this information to future Phil, that this is what we talked about and this is what we decided for their asthma. And we’ll check back in in the future. And it makes my life and practice so much better.
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I also will say that I don’t have to spend time in my visits like, oh, what brings you in today? Ah, fever. When did you have your fever? What were the associated symptoms? Like there isn’t that. You can just go into the room and talk to the patients because you are going to be
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able to keep much more of that in your head, get down where you need to and have a much more succinct visit and a much more enjoyable visit, both as the pediatrician and as the patient that’s experiencing it.
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Yeah, definitely. I agree that you can spend a lot less time charting. I find that when I do struggle with charting, it’s a little bit more because I still have those old habits. Plus, I’m a little bit of a perfectionist. And so I want to document things. But I’m like, okay, I have six charts.
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There’s eight charts to finish at the end of the day. I have to remind myself. I don’t have to chart nearly as much as I used to have to chart. And it’s really mostly for me and to cover myself medical legally, like you just said.
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And another thing that I’ve realized is for the kids that I see for the first time for like integrative pediatric consults, they can be quite complicated.
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Right.
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I’m going into nutrition and sleep and family dynamics and supplements. And like, I’m asking a ton of questions and gathering a lot of information and AI tools have recently become, A big help. Yeah. And so I use something called Freed AI for those more complex visits. And I really have loved,
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I’m still kind of trying to figure out how to optimize the use of those tools because sometimes it’ll make it almost too concise. And so I’m trying to figure out how to adjust the settings so that it’s the right amount of information, not too much, not too little, and have the key points.
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And of course I have to go over it, but it saves me so much time. I would have just spent like 15, 20 minutes I love documenting and now I can just go through and spend five minutes editing. For sure.
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I will say the same. I use NABLA, which is similar. I mean, they’re all pretty similar. Like, I don’t think there’s any that like stand out above the others by a huge margin. If it’s an ear infection or strep throat, I’m not going to go turn on NABLA and copy and paste all those sorts of things.
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I’m just going to click type and document real quick. I do a lot of like ADHD evaluations. I do pandas and autism evaluations and things along those lines. And like you said, those are more complex. And trying to document that as you go is a nightmare because you’re asking all
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these questions and then the patients are having verbal diarrhea all over you to tell you all the different things. And you’re wanting to be present and be able to think and not just be able to like document and click boxes and reviews of systems and all those things.
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So that’s exactly what I do when I’m going into the room. If I know it’s a complex or one, then I’ll just turn on Nabla on my phone or on my tablet or on my laptop. I’ll set that there and then I’ll just talk to the patients. And it’s amazing to just have those conversations.
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And sometimes I’ll repeat something that they said just to make sure that NABLA like picked up on it. But it’s not like, okay, I have to do an aside back. When I was in family practice clerkship, There was a doctor that would go into the room, and then he would say, hey, Mrs. Jones, how are you?
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One second. And then he would pick up his phone, and he would dial the number for dictation, and then he’d say, hold on. Mrs. Jones is a 67-year-old female who comes in today for… What brings you in today?
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Are you serious?
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For shortness of breath and cough that’s been going on. How long has it been going on for? It’s been going on for the past three weeks. And then, like, he would… Do the while he’s doing it. I mean, it was efficient. It was it was really entertaining. And the patients didn’t know any different.
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Like they would they would tolerate that. But he’s like doing the his whole. And then the person I felt bad for the transcriptionist because the phone would be like sitting here, you know, and he would be examining them and chatting with them and all those sorts of things.
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but that’s how I kind of feel like NABLA is in the background now of that like I don’t have to remember that two years ago they had a sore throat or fever or something like that and they’re wondering if that’s where it all started because
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it’s all grabbing that and then I could just go through and it will sort those things that has been a game changer for me too is to have that as the backup for those complicated patients or complicated stories that we’re getting that we don’t
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want to miss those things but we also don’t want to be typing it or trying to remember it three days later when we’re trying to finish that chart uh-huh
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I might have to pick your brain a little about the autism evaluations because I have not figured out a way to get it to perform the way I want to for those. But I know that it’s possible. And AI is going to continue to get better and better and more sophisticated. And so why not use it, right?
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I think the software I’ve freed AI is $100 a month. Totally worth it for the amount of time that I save it. $100 is like 30 minutes of my time. It’s worth well more than that. So absolutely worth it. And like you,
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I don’t use it for the simple visits because I have macros that I use or like strep throat and viral URI and some of the really simple things that are super fast, but I love the potential there in AI.
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You know, the one thing I think to linger on when it comes to the discussion of like adding Freed or NABLA or Heidi is another one, like one of those tools is that when you’re in a large group or when you work for a hospital or a large organization, if you say, I want to try this,
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there’s going to be 17 committee meetings. before you can even try it and how much time is going to pass by. Whereas in pediatric DPC, somebody said, hey, you should try NABLA. And I just went to their website and I typed it in.
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I didn’t have to put my credit card information in because you get like 30 free notes or something like that. I was trying it the same day. And so I think there’s a lot to be said for the allowance for innovation in pediatric DPC that you can’t do in a large group setting where 17 people have to
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sign off on it and we got to get a trial. And then we got to talk to HR and we got to talk to compliance and all those sorts of things where things often die in committee. You, as the business owner, just get to say, well,
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I want to try this tool and see if it works and see if it helps and integrate it in. Like there isn’t a big committee that has to give its approval and there’s all the naysayers and, oh, you guys, it was so much harder in my day.
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You get to see people that are saying all those things that just implement things that work for you and for your practice. And if it doesn’t work, then you just try something else.
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Yeah, absolutely. I love that. I love that freedom from TPC. And I hated those committees. I hated, I hated them with a passion.
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You know, I give some mental energy to how am I going to convince people that this is worthwhile? Like we had an in-person scribe program that I started in my previous practice. And I mean, I can’t tell you how many meetings we spent talking through all of the nitty gritty details of every single little thing. And now,
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like if we wanted to do that, it would be like, well, let’s find somebody and let’s get them in here. Let’s get them trained and all these sorts of minor hurdles that don’t take an hour to talk through in committee meetings where things go to die. So, yeah, it’s amazing.
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Yeah, absolutely. So, yeah, in short, we spend a lot less time charting in pediatric TPC. I would say, though, the one thing that can be problematic for some people is that there’s no boss that’s getting on you. to do your notes. So it’s all on you, right?
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So if you’re one of those people that needed that external motivator, that whip behind your back to get you to do it, Just be careful because you don’t want to end up falling behind on hundreds of notes and then you don’t know what you did.
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I feel like my office manager must have talked with you and said, can you kind of bring up how he doesn’t have a boss telling him to finish his notes, but he actually still needs to finish his notes. Yeah.
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Yeah. No, and you’re not the only one I’ve heard that.
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I feel the same in this moment.
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but it can be a struggle because again, like there’s no, there’s nobody enforcing that rule. So you have to figure out a way so that you get it done within a reasonable timeframe.
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Yep. Accountability is huge. And having the self accountability can be really hard when all of a sudden you don’t have people that are looking over your shoulder and you’re not getting the little Epic badges of completed all their notes by 11 or something third and terrible like that.
11:20
Yeah. Yeah. And then just be careful because like, let’s say a patient leaves because they’re moving and then they request their records. Like you still have to have something right to show. Like if they were there 10 times and then you send them something that has two visits, they’re going to be like, what’s up?
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You know, now you definitely talked to my office.
11:39
Yeah. No, I, yeah, that does happen. Yep. You do have to do those documentation, but hopefully those receiving pediatricians, somebody moves and they’re like, wow, they don’t have to document as much as we do. Maybe I should look into pediatric DPC because I have all the information about their ear infection that I needed to know,
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but there aren’t 17 pages for this visit. What’s the deal? How does that work? So then they’ll get motivated to start a DPC practice.
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Exactly. Exactly. Yeah. And maybe, you know, for, for people for whom that is a struggle where it’s like, oh, I know that I know myself, I know I struggled with note writing, just use AI every counter, right? Because then at least it’s there and you can go back and find what happened.
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At least it’s something I definitely forget.
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Yeah, totally.
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All right. Um, any last thoughts on this? No.
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No, I mean, you’re just going to chart a lot less when you jump over to pediatric TPC and you will just enjoy your life multitudes more.
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I agree. Great. Well, thanks for listening. And until next time.
