29. Physician Charting and Maximizing Efficiency with Dr. Junaid Niazi

 Do you feel like charting has taken over your life? Does it constantly get pushed to the end of your day, leaving you drained and lacking the motivation to get it done? If you're ready to regain control over your time and live more intentionally, this episode is just what you need.

Dr. Michael Hersh and Dr. Arpita Gupta DePalma speak with Dr. Junaid Niazi, a board-certified Internist, Pediatrician, and certified Physician Life Coach. In our conversation with Dr. Niazi, we explore the power of shifting our mindset when it comes to charting. It's common for physicians to delay charting due to concerns about keeping patients waiting. However, Dr. Niazi teaches us about the advantages of charting in real-time and highlights how it can ultimately benefit our patients, ourselves, and our families.

What you'll learn:

  • Why charting becomes overwhelming
  • Strategies for efficient charting
  • The impact of real-time charting

Featured in this episode:

  • Find out more about Dr. Junaid Niazi and his group coaching programs¬†HERE.
  • Learn the five essential tools physicians need to stop feeling frustrated, overwhelmed, and trapped in medicine¬†HERE.
  • Learn more about Dr. Arpita Gupta DePalma's programs with Thought Work, MD, including 1-to-1 coaching for individuals, group coaching cohorts for organizations, and her online self-study courses HERE.
  • Tell us what you thought about the show! Leave us a review.

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29. Physician Charting and Maximizing Efficiency with Dr. Junaid Niazi 

Michael: Well, hey everyone, and welcome to another episode of Doctors Living Deliberately. We're so excited to have you here with us today, and of course, I wanna welcome our co-host, Arpita. How are you? 

Arpita: I'm good. How are you doing, Michael?

Michael: I am great and excited to introduce everyone to our guest today. So today we have Dr. Junaid Niazi. He is a board certified internist and pediatrician working as a primary care doctor in the upper Midwest, and he's also a physician coach and an entrepreneur, and I'm so excited to introduce him to everyone. How are you, Junaid? 

Junaid: Hey, I'm doing great. How are you guys? 

Michael: I'm doing really well. So you and I actually go way back, because you were one of the coaches in the first physician coaching program that I enrolled in, and I always loved being coached by you. And I will never forget the time that I told you I was thinking about becoming a physician coach. Arpita, this is a hundred percent true. Junaid must have stayed on this call an extra 30 to 45 minutes to give me all the details, everything I needed to know. He is so genuine and so genuinely interested in this space, and just physician wellness. And so that's why I, when we were creating this podcast, I knew I wanted to have him here with us. So, anyway, welcome, Junaid.

Junaid: Well thank you. And thank you for those kind words. I had to drag another guy into the, the world of physician coaching, so.

Michael: Yes, for sure. 

Junaid: There, there is maybe a little self-interest there too. 

Arpita: There's nothing wrong with that.

Michael: Not at all. Not at all. So why don't you tell us a little bit about your own coaching journey. How did you find coaching? 

Junaid: Yeah, well if you go back to late 2019, early 2020, I was pretty enmeshed in the physician financial blogosphere, like the white coat investors, the passive income MDs, the physician, philosophers, et cetera. And I started to see a lot of those folks start referencing coaching, and at first I thought this was just sort of like Tony Robbins, rah rah rah, woo woo kind of stuff. And I wasn't really that interested, so I just sort of ignored it. But then it kept coming up and kept coming up. And all the people that were doing really cool things in their lives kept referencing coaching and mindset work. A couple of names kept coming up within those circles. And so I started exploring it, came across the Life Coach School podcast by Brooke Castillo and started listening to some of that. Then learned about Dr. Sunny Smith, who runs empowering women physicians. And I was pretty intrigued. I started doing some self coaching, some thought downloads, and I was like, oh man, this is, this is actually kind of useful. If you write your thoughts and your feelings down, you start to discover things about yourself. 

And I decided I wanted to actually find a coach and I wanted to find a physician coach. And I spent like the next several months just striking out left and right because all the physician coaches I found were women physicians who only coached other women physicians. And I would reach out and ask them and they'd say, sorry we only coach other women physicians, try this person. And I just kept trying person after person. And I occasionally get redirected to a male physician who has a label of a coach but doesn't really do any sort of thought work, more sort of action line consulting type work. So that's not what I was looking for. And then I joined the Leveraging Growth Accelerator as a group run by Dr. Peter Kim and Dr. Pne Par and Sunny had opened in there. Dr. Sunny Smith had said, Hey, anyone can join my Empowering Women physician. So I emailed her and I said, Hey, I've been looking for a physician coach, and you said it's open to anybody and the name is for women physicians. Can I join? And she graciously said yes. And basically I went through her program got coached by some amazing people, including Dr. Smith herself on group coaching calls and one-on-one calls and decided to become a coach because I was like, man, I can really accelerate my skills and the benefits I've gained from coaching for myself if I become a coach.

And then as I went through that process of becoming coach, I realized I need to share this with with others. And there was a little bit of maybe a pull at the heartstrings of there's so few men physicians in the world of coaching that it almost felt like an obligation to share it with other men. I came across Dr. Jimmy Turner, the physician philosopher, who had also found coaching. And we were in the same cohort training to be physicians and started coaching in his program, the Alpha coaching experience, which is where I met you, Michael and was just coaching physicians one-on-one initially, and then I was later able to transition to sort of my own group coaching model from there.

Arpita: Hmm. Awesome. So tell me what made you like, you kind of touched on it a little bit, but you heard about coaching from all the different programs and the other things that you had become a part of that weren't necessarily coaching, but why did you feel like you needed coaching for yourself specifically? What was the breaking point in a sense? 

Junaid: Yeah, that's a great question. You know, I think it was looking at my life on paper, it seemed like I had sort of all my ducks in a row and everything should have been hunky dory and life should have been amazing and there were just parts of it that didn't feel that way, and I didn't really know why. You know and I think maybe prior to coaching, I was like, if I just check all these boxes, if I become an attending, if I get married, if I have kids, if I do this and that, I will be successful and I will be fulfilled. And I got to the end of that to-do list, life to-do list. And I was like, huh, well this still doesn't feel fulfilling in any way. And I started to wonder why. And I kind of got caught up with that financial independence, retire early movement. And that was kind of the goal there is if I just put the work in in the early years, then I can just sort of pull the cord and escape later. And I realized I didn't really wanna escape from something that I enjoy doing. So what about what I was doing was I not enjoying that made me wanna even consider that? And I started to explore that a little bit. And so, that sort of illuminated for me all these areas where my thoughts about the facts and circumstances of my life were really driving the actions I was taking, which is why I was feeling sort of unfulfilled.

Arpita: Yeah, it sounds familiar to me. 

Junaid: Yeah. Come across that once or once or twice. 

Michael: I mean, your story and my story are essentially the same. I mean, that is exactly what brought me to coaching as well. And I think it is the story for so many physicians and in particular, I, I'm gonna go out on a limb and say male physicians. And why do you think it is that male physicians, like, why do you think this happens so commonly for us? 

Junaid: Well, I think it's you know, a lot of it is sort of sociocultural what's been modeled for us, what's been ingrained in us. And that's you know, you should be successful, you should work hard. If you do the hard work, you'll be rewarded on the backend. And you know, a lot of that isn't always true. And as you start to explore that, or, you know, for a lot of physicians think early days of the pandemic when a recession proof job was suddenly, you know, found tons of physicians at the onset of a infectious disease, like not employed and not caring for patients, which I never thought I would see. That was really eye-opening. But I think a lot of men, this is not emphasized, we're told to just, you know, compartmentalize, bury this deep and forge on and to a degree, I mean, I'm still pretty darn good at compartmentalizing and I have to be really intentional and it has its uses. I won't say it doesn't have its uses, but I have to be really intentional on pausing and intentionally sort of exploring those thoughts and doing that. That journaling or just that sort of self-reflection. And like you, you know, the title of your podcast, Doctors Living Deliberately. If you wanna live deliberately, you have to go with intention. And that means where are you putting your time and your focus. And so many of us are told we have to keep up with the Joneses and hit these milestones as these sort of tangible achievements when, when really it's about enjoying that journey. To get to those things as well as just enjoy the other aspects of life, right?

Like, you know we were joking before we started recording about kids being in school and such. And, you know, I love my kids dearly. I love having my kids, but when I think about like school and stuff like that, and if I don't check myself, I start thinking about all the negatives. Oh gosh. Like vacation is gonna be so much harder to take now. Versus like, how cool is it that my kid is like learning to read and doing this and that and I get to help shape his personality and he is a little jokester and you know, my daughter and you know, learn potty training, all that kind of stuff. Like when you stop and think about those things, it's just like amazing what we get to do in life and the experiences we get to have, but I think especially for men, we're just told like, you have to achieve X and you need to get there and there's no focus on that journey there. 

Arpita: I think what I can pull out of this, just even cause my husband went through a coaching as well, you know, and he's a physician as well, and so when he did that, I think what he reflected to me later was that, I remember specifically right before Covid was that he felt he had this huge weight, this huge burden to supply or provide for the family and be the primary breadwinner. Not that I wasn't doing anything, you know, I had my own suitcase I and had to unpack about all that, but so that burden of this weight that I have to keep doing anything kind of gave that tunnel vision that I have to keep doing it so I can reach that end goal and not being able to recognize all the things that you're missing on the way. And so, part of it, and I think part of the reflection and part of the growth was recognizing that we don't really always have to have that goal specifically. And also, even if we do have that goal, how do we do it so that we're enjoying the process along the way? How do we enjoy that ride? And it might mean that it's not reached at the same time, but does it really matter? Right? And so there's so many different pieces of this that our brain just goes into the automatic thought processes of we have to do it, we have to do it, we have to do it. And it doesn't allow us to think outside of that box. So from his perspective, I get what you're saying. This is male perspective, cuz in a traditional home, it's the primary breadwinner. It could be male, it could be female, it could be whoever, but that's I think the burden that falls on that person that they might be getting stuck in that routine or that kind of automatic behavior. 

Junaid: But yeah, no, totally. 

Michael: Now one of the things that you really enjoy coaching on is charting. And so where along your coaching path, did that become a passion of yours? And tell us a little bit about how you've integrated that into coaching now. 

Junaid: Yeah, well it's, you know, it's one of those things I didn't recognize in myself as sort of being good at charting. But it was something I really had to get intentional about after I started my first job. Cause my wife is a, a pediatrician outpatient as well, and, we'd spend our evenings and our weekends just, you know, clacking away at our keyboards. And that was before we had kids. And so I realized something had to change. So I got really intentional about, how can I develop systems and efficiency? So I actually worked on sort of the, the action line side of things first and figured that out, which took years. And then later after I discovered coaching. I realized, oh man, if I had focused on my mindset about charting, that would've accelerated my journey like tremendously. But I also was able to recognize and have some gratitude for the fact that there were some mindset shifts that I had made without realizing it or recognizing along the way. 

Getting back to your question, when I was coaching in Dr. Jimmy Turner's program, you know, I was always piping up in the chat on the group coaching calls whenever clinic questions came up, or, or things like that. And so it was Jimmy himself who challenged me. He said, Hey you're gonna host a charting efficiency masterclass for our clients. And I said, oh, okay. And, you know, I prepped for that and I did that and I had a ton of fun with it. And then the folks who actually attended that I think had had a lot of benefit. And I realized like, oh man, I have a niche. And so I just sort of took it from there and ran with it and, you know, that was, spring of or maybe fall of 2020, early 2021. And a little later in 2021, I launched a group coaching program called Charting Conquered. And since then it's we're, you know, 200 plus physicians in, and most recently I just started a parallel program also for APP's. 

Arpita: Very cool, very good. I think a lot of this is, like you said, it's the mindset. But part of what I think really impacts where we become crippled with the charting is the A. The perfectionism, right? That we are fearful that it needs to be perfect and it's, everything is documented, but also the repercussions of if it's not, which are kind of again, going back to our thoughts. And then also just making it a priority to say, Hey, I'm gonna be committed to getting this done in this timeframe that I have. And I'm not saying that it's okay that our visit times are getting shorter and the amount of work that we're expected to do is not getting higher. It is. But how would you tell your clients, what are some tips that you can give them with how you can actually make it so it's more efficient that you can get your charting done in between while you're seeing the patients or in between the next one? What are some of the tips that you give? 

Junaid: Right. And before I jump into those tips, I just wanna say you're spot on with that. It is the fact that for so many of us, charting has become a sort of an afterthought of our clinic day. And then we leave it for some other time, but then it just sort of knaws away at, at us and our souls and impacts how we show up in the rest of our lives, really. But you touched on the main thing that I usually tell everybody if they ask for just one tip, I'll say, you know, you really have to chart as you go, meaning you have to get your notes, your orders, everything done for every encounter. Either during that encounter, like before the patient gets up and leaves. And I'm a clinic doc only, so here I'm just talking in the clinic. Or right after you finish seeing them and you've just gone back to your little pod or office area. And you know, a lot of folks have a lot of objections to that. Well, I'll keep somebody waiting longer or that seems disrespectful or I can't do that cuz it's gonna take me forever to chart. And I, I really love to challenge people on those thoughts and I call them thoughts. Yes. Because when they look at it, it's usually like three to five minutes of work that they have left max, and often it's two to three minutes. And if you can put in two to three minutes now you can go to your next encounter completely unencumbered by any other residue from your prior visits. Right? So I'm not worrying when I go see patient number 10, you know, which patient had that heart murmur? Oh gosh. Like where was that rash? Which leg was amputated? Like I better get that right in my note. Like I'm not worrying about any of that because if you haven't documented that, whether you know it or not, you're keeping that somewhere in your working memory, and it is siphoning off your bandwidth to be fully present for the patient in front of you.

So I as usually tell those people, it's actually disrespectful to bring everybody else's baggage along with you to your next patient encounter. And when you save your chart for later in the day, and now you have to go and try to access your memory and pull forth all those details, it takes you way longer. Plus your brain is just more tired at the end of the day. So if you can get everything done, in one nice little package, you're gonna move so much faster. 

Arpita: Yeah, I wanna just say I with you talking about that, I remember, I don't know if this was a good incentive, but for me, my incentive was if I don't do it right now in two hours, I'm not gonna remember which ear had the infection. And so for me, that was the incentive, the fear of I'm gonna make more mistakes if I don't do it right now. And so I think that's where you kinda have to reframe that we are perfectionists and maybe part of it is that you're not able to reach your max potential when you're not doing it right away.

Junaid: Yeah. Yeah, that's, you can tap into, I guess, the perfectionistic argument from that angle, but, I don't wanna like ebb that on and, and encourage perfectionism. Cause I think it shows up so much in everything we do already. 

Michael:  I do find also that charting issues come up all the time when I'm coaching physicians. And one of the objections that you just brought up was I'm gonna keep somebody waiting. Mm-hmm. And what I offer to physicians who offer that as a reason to not chart as they go is that if they don't do that, they still keep somebody waiting but the person that is waiting for them is their spouse, their children, all the other people that are waiting for them at home or that you are distracted away from when you are at home because you're just like, okay, I'll, I'll come play with you in a few minutes. I just have to finish my charting. And so who would you rather keep waiting? And make that choice deliberately and with intention like you were talking about earlier.

Junaid: Right. And you know, for every individual patient you might be, you know, we might be talking about keeping them waiting 10 minutes versus 12 or 13 minutes. Add that up and by the end of the day, you're keeping your family waiting like an hour plus, hour and a half, two hours, what, whatever it may be. So you're spreading the, the love maybe in a way you can think of it. To all your patients, right? But there's an interesting study that did sort of a, a time audit of ambulatory physicians in four specialties. And when you averaged out all the time they spent doing various tasks, like people followed them with a stopwatch and a clipboard. Physicians were spending 27% of their time seeing their patients and the other 73% of the time on like bureaucratic tasks, which is usually proving that you saw the patient for that 27% of the time. So talk about, you know, moral injury and burnout. We are highly trained professionals. We've put in hours, sweat, blood tears. Society has invested lots of money in us as well to become physicians. And we're spending barely a quarter of our time actually doing the thing we were trained to do. And this is one of the biggest drivers of, I call it burnout in the literature it's called burnout. I know some people get a little caught up with that and say, it is moral injury. And I get the point they're making there. You know, moral injury is a system problem that's being sort of done to us versus burnout sometimes can be seen as victim blaming, but even the good people that are fighting the good fight in other institutions and in academics and in the literature refer to it as burnout. So if you hear me refer to it as burnout, that's why. 

So I think you asked for three tips, so I can give you a couple others. So another one I'd really like to help physicians with especially like inbasket is touch everything once. And what I used to do that made me feel really productive and get nothing done was I'd click on every little item in my inbasket to like mentally triage it. And then I'd right click on it and mark as new because I hadn't taken any action. And then I'd go through and finish doing all of that and I'd probably start over because I forgot, cuz you know, there was 30 things I just clicked on. So I really work with clients to be like, what if you just clicked on something and just did it there and then? Choose whatever in-basket folder you're gonna work on. And I usually say choose something that generally will lead to more inputs coming into you. So refill requests, right? If you don't address that, within a half day you might get another call about it, which is pulling your staff away, pulling your attention away, interrupting you in some other way. Just go through those, go through you know, your labs and your other results and such. But don't just keep clicking on things to look at them to see, is there something important in there I need to address? Because you're gonna have to address it anyway in some sort of timely fashion. And you know, I used to waste five or 10 minutes at a time just between patients doing that kind of thing. So if you can touch it once, that's the best approach for that. 

And the last thing is assign everything a time. And, you know, we tend to be scheduled up to our teeth in patients. So we start at this time and we see patients till this time and then we're supposed to go home and attend to the other obligations and duties we have. That's not realistic. So look at your schedule ahead of time and say, okay, I'm gonna really try to hold these folks to really, you know, strong agenda setting. And we're gonna talk about X, Y, and Z only at these visits. This might gimme five minutes after this visit. This person's coming in for just like a urinary tract infection. This will be a quick visit, so I'll have probably 10, 15 minutes there. Then say, what is the most important thing I need to get done outside of seeing my patients? Maybe it's calling a patient back about that new cancer diagnosis, that biopsy result that came back. You know, maybe it's calling someone about their parent and they're worried about dementia and getting them in a higher level of care, like a assisted living or something. And, and getting that process rolling and say, that's my first priority. I think I can get it done here. This doesn't need to be perfect. It just needs to be good enough. And you'll see, as you get good at this, as you practice this, you'll get better and you'll start to trust yourself. Okay. I told myself I'll get five results done. I got five results done. But sign at a time and don't focus on being perfect again. Perfectionism tends to hamper us in a lot of ways.

Arpita: Yeah. I have one tip that I remember from vacation, cause I know the docs we dread coming back from vacation because that inbox is like pure hell. Right? Right. And so one of the lectures or webinars I was watching, they suggested that when you return from vacation, number one, the first day back, don't schedule any meetings. Make sure you've built in time to tackle the catch up work, which is the inbox. But also, after that, each day as we continue, we're still getting the whole full inbox refilling, right? So whatever process you have getting through that day's inbox, continue that, and then give yourself maybe an hour allocated each day just to go back one day's worth. And so then you've scheduled it so that you will not be overwhelmed by all this huge number of inbox things that are waiting for you. You devised a system to be able to tackle it systematically so you don't feel that overwhelmed. So I thought that was a really helpful way to think about it because we all deal with that when we come back, whether or not we're actively practicing or not, that inbox is there. Right? 

Junaid: Yeah. Right. That's, you know, that's only gotten worse at systems that use Epic, you know, they say, MyChart messages, for example, are up or portal messages are up 157% since the pandemic started. I know at my organization it's a multiple of that. And so yeah, inputs coming in can be a huge drain and it's so hard to go on vacation and be at peace and spend time with your family and enjoy yourself and recuperate when you're just like, oh, what am I coming back to? And so, so many physicians like don't take vacations. I dunno if you've had any partners who are like that. It's sad. 

Michael: I mean this continues to be an ongoing struggle for me when I am on vacation my computer is almost always with me. And you know, I, I don't necessarily log in every day, but I do, I have that fear of coming back from vacation and seeing a thousand messages waiting for me in my inbasket, and I would rather spend an hour of a day, each day on vacation tending to messages, then come back to, you know, the feeling of overwhelm. And, you know, I, I am somebody who also I think is very efficient with my charting. I do chart as I go. But the vacation stuff, that is still something that remains a challenge for me. And so for all of you who think that, like the coaches, we've figured it all out. You know, we, we have some of the keys, right? But it's all ongoing work. 

And I'll offer one other thing that I think is super important. We talk about celebrating wins here all the time. Mm-hmm. And so if you're charting as you go and you get to the end of the day and your last patient is at 5:00 PM and you get through the end of that last patient and you close your chart as they walk out the door and check out, make sure you celebrate the win, the fact that you've closed all your charts for the day you're done with all of your charting. That's a huge win, and don't forget to take a minute to celebrate that win because that will encourage you to keep going.

Junaid: In my program, I, I send clients a workbook, and the last two pages are a bingo card related to charting. And then depending on, you know, if you get a straight line or an x or a blackout on the card, I have suggested celebrations you should do. So I'm totally all about that celebrating. 

Arpita: Well, Junaid, I think these have been some amazing tips, very helpful for our audience today. I wanna thank you for joining us. Tell our audience a little bit about how they can learn more about your programs and what you have to offer. 

Junaid: So my program is called Charting Conquered and it is a hybrid online course and group coaching program. So there's some online modules you can go through that cover a lot of these topics. We cover, you know, a lot of clinic workflow issues like best practices for getting through your notes, best practices for charting as you go, in basket. But also we, I mean we talk about perfectionism, imposterism, your value as a physician. All those sorts of other topics that we really don't have any other venue for talking about. But the real power I think comes in the group coaching calls. And what I love about group coaching calls is that, you can benefit even if you're not getting coached. And so I think there's this funny thing that happens when there's just one degree of separation between an issue that you're facing and you interpretation of it, you're like harnessing different parts of your brain. And let me be a little clearer about that. So if I'm struggling with something in clinic, I'm usually so wrapped up in the story about it, like, oh, I can't believe this is happening to me, or so-and-so did this, or the politics of this, or just, you know, I'm not gonna be able to navigate this. Whereas if you hear somebody else, like getting coached about it or talking about it, you're starting to tap into your prefrontal cortex a little bit more and trying to, you know, really do the physician work. Like, how can I solve this problem for this person? And then you start coming up with ideas that apply to the person being coached and then you realize, oh my gosh, that can totally apply to me. And for me, that's always been the fun of group coaching. That's why I love that format. 

So my program is actually sort of ongoing, so you can join any time and then you just start getting the course modules drip to you weekly and you can, you'll be able to join the next group coaching call, which are weekly, and I have another coach with me Dr. Peter Baum. He also coaches with me in that program. And if you're struggling with charting, I have a lot of blog posts and a lot of resources including how to join my program on my website, prosperouslifemd.com.

Michael: Amazing. Well, this, I think is gonna help so many physicians. Dr. Junaid Niazi, we are so grateful for you coming and spending some time with us and sharing all of these tidbits with our audience. And if you are listening to this and this resonates with you, go and check out his website, prosperouslifemd.com. And again, thank you so much for being here with us today. We, we so appreciate it.

Junaid: Thanks for the invite. I love being here. 

Michael: We'll see you next time on Doctors Living Deliberately.

Arpita: All right, bye-bye. 

Michael: Bye.

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