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‘Hundreds of forms every day’: How paperwork can lead to GP burnout


Evelyn Lewin


22/04/2021 2:27:10 PM

GPs have lamented the increasing paperwork associated with general practice, along with the lack of time and funding to complete such tasks.

Pile of paperwork
Almost half of survey respondents said clinical documentation significantly contributes to exhaustion and burnout.

When Tasmanian GP Dr Tim Jones spends time with his colleagues in the lunchroom, they often discuss the most challenging parts of their day.
 
And the issue that garners the most frustration usually centres on the logistics of working in general practice.
 
‘Paperwork is normally top of that list,’ he told newsGP.
 
‘It seems to always be more than we have the space and time to handle.’
 
For Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology and Management (REC–PTM), Dr Jones’ story is all too familiar.
 
‘Definitely there’s a lot of stress with the amount of documentation that’s required these days,’ he told newsGP.
 
Both doctors believe there is currently more documentation required in general practice than ever before, and that the causes are multifactorial.
 
Firstly, Dr Hosking says, GPs nowadays are very aware of needing to ensure their notes are detailed for medico-legal reasons, which may be a reflection on the ‘increasing tendency to litigate’ in recent years.
 
‘Partly, they’re writing notes as an aide memoire in case they have to present those notes or write a report about the patient, so they want more detail than they used to have,’ he said.
 
‘[But] doctors are [also] concerned about making sure everything’s documented carefully, and they can prove they did what they were supposed to do.’
 
However, it is not just patient notes that consume doctors’ time.
 
‘There’s lots of extra documentation from various organisations now that seem to tie us down in red tape,’ Dr Hosking said.
 
He says this ranges in breadth from filling in applications for disability car permits, through to managing systems such as real-time prescription monitoring for opiate drugs.
 
‘Then there’s all the various systems that we have to complete that seem to be wanting more detail than we used to have,’ he said.
 
Dr Hosking points to death certificates as an example, saying that in Victoria, death certificates used to require minimal information.
 
‘And that was written on paper,’ he said.
 
‘Now, we have to do it online and are required to find out the details of the funeral director, and the next of kin; so there’s a lot more pressure on us to fill out more forms and in more detail.’
 
Referring a patient to hospital can be a lengthy administrative task, too.
 
‘Hospitals are now requiring us to use their particular template and if we don’t use their template, then patients won’t get seen,’ Dr Hosking said.
 
‘So we have to track down which template [we need] for which hospital, for which clinic.
 
‘And if you use three or four different hospitals in Victoria, there’s a chance there’ll be three or four different forms for each clinic.’

Billing places additional pressure on GPs.
 
‘There’s more and more Federal Government pressure on us in regards to documenting things such as our Medicare billings,’ Dr Hosking said.
 
‘We have to be accurate in our selection of the right Medicare number. If we make the wrong choice there, we run the risk of being audited by Medicare and having to repay the money.
 
‘So there’s pressure from all directions.’

Paperwork-burnout-article2.jpg
Dr Tim Jones believes the amount of paperwork associated with being a GP is on the rise.

These anecdotal experiences are reflected in a new study by Nuance Communications and the Healthcare Information and Management Systems Society (HIMSS), which shines a further light on this topic.
 
The study involved an online survey with 416 participants from 10 countries, including Australia, and a qualitative telephone survey involving 27 respondents.
 
It found that a majority (58%) of Australian nurses and doctors say their job leaves them feeling burned out, with 97% of participating doctors confirming they have felt burnt out at least at some point in their work life.
 
Of particular interest, in Australia almost half the respondents agree that clinical documentation is a burden that significantly contributes to exhaustion and burnout.
 
Dr Jones understands why the reams of clinical documentation associated with being a GP causes such an impact on the emotional wellbeing of clinicians.
 
Even though he says dealing with clinical documentation is a ‘common challenge’ in general practice, he does not believe the current system is adequately set up to manage such pressures.
 
In the past, he used to write his notes directly after seeing each patient, but as the paperwork load has increased Dr Jones has begun finding more ways of incorporating that into patient consultations, despite the fact it can sometimes impact on patient care.
 
‘The paperwork can be an unhelpful distraction sometimes from a patient’s needs and can pull them out from a really therapeutic intervention because you’re trying to sort out paperwork around them,’ he said.
 
‘[But] there hasn’t really been any shift in how we operate as doctors to give us added time in which to do that.’
 
Currently, he says it is up to individual clinicians to look at their workday and ensure there is adequate time scheduled for administrative tasks, including writing patient notes.
 
However, he says there is no financial incentive to do this.
 
‘Ideally, [that should be] incorporated into how we’re paid, as well,’ he said.
 
While salaried hospital doctors often have inbuilt clinical support time, GPs are often not remunerated for the time spent on administrative tasks.
 
Dr Jones would like to see changes in the system, but also believes better education is needed for patients.
 
‘Often patients turn up with a request that they may perceive to be simple in terms of paperwork, but may actually involve a huge amount of work,’ he said.
 
‘Something like an NDIS [National Disability Insurance Scheme] application, for example.
 
‘So educating our patients that paperwork needs are higher and to account for that when booking time with a doctor or nurse [is important].’
 
Utilising more advanced technology during a consult may further help further address issues relating to clinical documentation.
 
According to the study, approximately one-third of participants of the online survey thought that artificial intelligence (AI)-powered speech recognition technology could help relieve this burden.
 
Dr Jones agrees this is an idea worth exploring.
 
‘There’s some interesting possibilities in terms of recording consultations and having voice detected transcribed consultations,’ he said.
 
‘As a doctor, I have no fear of that type of technology because I feel it leads to very accurate documentation of what has taken place in a patient encounter.’
 
Dr Hosking believes streamlining documentation can further reduce the burden associated with it.
 
‘[REC–PTM is] trying to work with computer software vendors and various levels of government to try to reduce the amount of manual entry we’re having to do,’ he said.
 
‘We have a continual battle with organisations such as hospitals and governments developing forms that they want filled out their way, but that is not compatible with our software.
 
‘So we have to go to a website or go to a form and manually fill in every detail about the patient and ourselves before we even start getting to the reason that we’re actually writing the form.
 
‘We’ve been pushing for a long time that all new forms developed by government should be run by organisations like ours to see how they can incorporate it in the first instance, before they develop it to make it work with our GP software to make it easier, so there’s less filling out to be done.’
 
He says the importance of streamlining paperwork is of obvious benefit to GPs, but other organisations may not understand its significance.
 
‘For them, it’s just one form,’ he said.
 
‘But for us, it’s hundreds of forms every day.’
 
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Dr Tom Owen Morley   23/04/2021 9:02:36 AM

This is the sole reason I left GP at the end of 2020. The pay and level of job satisfaction was just not commensurate with the effort and time to manage the bureaucratic onslaught. Although it was sad to say goodbye to long-term patients, I cannot imagine ever going back to GP.


Dr Louise Marie Edwards   23/04/2021 6:34:46 PM

Accurate and sufficiently detailed consultation notes are tkes the GP time in the short term, for which we don't receive commensurate remuneration. However, in the long term, without accurate notes to equip the medical management to progress, the patient and subsequent GPs lose time in recovering'old ground', not to mention possible exposure to risk of repeated tests/ investigatios. In other words, it is an efficient endeavour to make comprehensive , contemporary notes, but the time that this takes to achieve this is not currently supported by commensurate remuneration
Similarly, the time taken to compose an appropriately detailed referral letter is very efficient in the long term, but does not receive adequate remuneration.
I was taught these concepts 26 years ago, when I started my career as a GP. At that time,I would never have imagined the magnitude of the increase in"administrative" time,nor the partnering "virtual flat line" of the Medicare rebate.