What did she do before? Did she use paper? Here is what I envision when I see her in a room.
I see an MA triage the patient and write vitals on a sheet of paper that may have the chief complaint on it. I then see her enter the room and begin talking to the patient, taking a history and finally an exam ALL without even having the chart open. I am JUST guessing. After a twenty minute history and exam, it would be time to chart it, but there is now an empty chart with nothing in it. Am I wrong?
Instead, my MA would see the patient in the triage area. The chart would have already been sent to her from the receptionist. She triages the patient, enters all vital signs and takes a very thorough and good history. The chart is then forwarded to the room in my inbox.
So, from there, your doctor would walk in the room and have a little idea of what the CC was from the Superbill on the clipboard. She would walk over, say hi, then unlock the computer and pull the patient's chart from her inbox. So, at that point, we are talking 30 seconds. She briefly reads the HPI, then hits the return key and begins to interview the patient based on what she has read and fills in the spaces. That takes two to five minutes. The ROS has been filled in by the MA, and you check them briefly. You always have enough to count for a 99214 if you need it. The PMH and PSH are pretty much the same. I generally, open the script writer and go over the medications. With ROS check and medications check we are at four to seven minutes.
Now, you do your exam. As one doctor taught me, you can do an awful exam in three minutes and a great exam in five. Something tells me she does the great one. Now we are at nine to twelve minutes.
You finally sit down to actually finish your note. You use a template to enter the exam findings and tweak it a bit to add another finding. Less than a minute.
You must choose a diagnosis/assessment and possibly why you came to that conclusion. You then document a plan and possibly print out the plan or some information sheets. This process should take about four to five minutes. So, we are at 14 to 19 minutes.
You close the note, then sit and chat with the patient for 30 seconds and answer questions. This will likely be a 20 minute appointment. So, since she has 15 minute appointments, they average out with one being a five minute or less conjunctivitis and another being a 35 minute Type II diabetic.
I understand everyone who charts later. I understand that she doesn't want the full waiting room. Not sure the layout of your office, but how about trying one day where she doesn't SEE the waiting room and just works right along finishing every chart she can. Take it to the extreme and after you or her MA tells her that she has seen the last patient, she should just walk out the day, eat at a nice restuarant, grab a bottle of red wine and curl up by the television. Then you know it can be done. Worse thing that could happen is she gets an hour behind, her patients who love her stay and wait, and maybe one patient leaves and goes to the ED where they wait four hours more.
