Coping with paperwork

Dr Mahibur Rahman

This article was first published in 2005 and is reproduced with the kind permission of Hospital Doctor, who retain the copyright.

We all have to deal with paperwork everyday – from referrals to other specialties, to clinic letters or discharge summaries, it can all build up. Sometimes it can seem that we spend more time dealing with paperwork than dealing with patients. This article looks at ways of coping with paperwork effectively so that you can free up more time for clinical work or relaxing in the mess.

Organise the paper mountain

The first step to dealing with paperwork is knowing exactly what you have to deal with. To do this, you need to organise the stack of papers into some sort of order. If you have let a large amount to build up, this can be very painful at first, but the rewards in the long term make it worthwhile. If you have paperwork in more than one place, it may help to gather it together in one place. Once you have everything together, you need to sort it into categories:

•  Clinical (referrals received, referrals to others, discharge summaries etc.)
•  Non-clinical work related – study leave applications, annual leave, exams, GMC annual fee payment, etc.
•  Other – tax returns , drug company literature, unsolicited mail, invitations to meetings, etc.

Prioritising the workload

We can’t do everything asked of us all at once (although many people expect this), so you have to prioritise the workload. Having organised the paperwork makes this easier to do. Each category can now be sorted into URGENT, PRIORITY, and ROUTINE (much like prioritising new referrals for a clinic). URGENT work is that which needs to be done immediately, PRIORITY work is work that should be done within a day or two at most, and ROUTINE work is work that can wait until you have spare time, without affecting the outcome.

You can now focus your mind on getting the most important things done first – this will normally be the URGENT clinical work. This might be arranging an appointment for someone with a suspected malignancy, or a transfer letter for a patient going for further treatment in another hospital. Dealing with some paperwork may require immediate action – such as checking blood results or pathology reports.

Remember that the importance of paperwork can change with time – a routine non-clinical task such as completing your tax return can become a priority when the deadline draws close!

Keeping on top of the paperwork

Once you have organised yourself and worked through the backlog, it is important to keep on top of the paperwork so it does not build up and become unmanageable again. There are many simple things you can do that can help ease the burden. These include:

•  Dictate clinic letters after each patient wherever possible – the details are all fresh in your mind, and you won’t have to look back at the notes.
•  Write or dictate discharge summaries as soon as possible after the event – again, this reduces the time spent looking back through the notes.
•  Keep a list of outstanding paperwork so that nothing “slips through the net” and gets forgotten.
•  Don’t forget about important non-clinical paperwork – it is easy to overlook – you need study leave and annual leave to maintain your skills and your sanity.
•  Try to set aside time every day or every week specifically for paperwork.  You are more likely to do it when it is timetabled, and regular small amounts prevent large build ups. Even half an hour helps.

Don’t forget about electronic paperwork – these days, you may receive or send correspondence (including referrals) by email, and soon this may become routine.

Finally remember, that no matter how high the paper mountain gets, it can be managed if broken down into smaller chunks.

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