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Banish your paperwork mountain with practical one-touch method

Mounting paperwork can irk patients and colleagues and cost you dear ­ Dr Jason Twinn shares some coping tips

aperwork is the scourge

of modern medicine.

We all hate it and, despite assurances from our trusted leaders, it seems to increase steadily.

Failure to manage paperwork means delayed reports, irritated patients and colleagues, and lost income (if you charge for reports based on time for completion). Managing paperwork is an essential part of being a GP and an area where VTS schemes seem to leave registrars dangerously under-trained.

In an ideal world paperwork would fit nicely into the time left after surgeries, visits and meetings. Unfortunately it doesn't come in an aliquot that small, so you have to find ways of making it fit.

Dealing with the incoming mail is the first skill: deciding what to read, what to keep and throw away, and how to file it. More meticulous colleagues file everything in neatly arranged folders until shelves collapse. I am ruthless in disposing of unnecessary paperwork.

It is easy to delude yourself that you might just read it later when you get the time. Besides, almost anything important now can be found on the internet.

Without sounding like a happy-clappy advanced-access doctor, it is best not to put off until tomorrow what should be done today.

The important word is should: you need to prioritise. Referral letters should be done either when the patient leaves the room or when they are still there. Putting them in a tray to do later inevitably leads to missed referrals as notes disappear when another doctor needs them.

Don't agonise over what to do with results and leave them in a pile to think about. You have a number of outcomes, such as appointment, prescription, referral or repeat.

Try sharing any doubt with the patient or a colleague. Try to develop a one-touch technique: deal with it as you see it rather than procrastinating.

It is vital to ensure your office system is robust. If you tick the box saying the patient should make an appointment, you need to know who will contact the patient, and what they will do if they are unable to make contact. All these eventualities must be thought through.

My tips on prioritisation

Consider using a back-up system like the task list on Microsoft Outlook, or a similar piece of software, to ensure nothing is missed. Most software consulting systems have task tools, or perhaps you like to keep a separate paper record every time you tell a patient you will refer them or use a task list on a PDA (which can synchronise with Outlook).

Then, of course, there is all the rest. I prioritise in the following manner:

lall clinically necessary stuff

lany work that attracts a fee

leverything else waits till I have time.

Examples of the latter are those silly little green IB113 forms from the social security office.

You have to strike a balance between efficiency and burnout. Letting huge mountains of paper grow is more of a heartsink than the worst of your regulars, but then you can't do it all today and retain even a modicum of sanity or enthusiasm.

Being unrealistic is


Some GPs come in half an hour early every day, others squeeze it between patients and into their working day. Others stay late or take it home. Some argue that the last option is the worst as it blurs the divide between work and home, but it largely

depends how understanding your spouse is.

Being a perfectionist and trying to read everything and always having an empty tray is incompatible with being a full-time GP. There is not enough time to read all the rubbish we get. Setting unrealistic goals is not only demoralising, it is self-destructive.

Minimising the effort

involved in paperwork

 · Avoid procrastination

 · Learn to prioritise

 · Delegate to office staff

 · Be realistic about what to read and what to keep

 · Find a time in the working day to do paperwork

 · Use a back-up system

for referrals

 · Ensure your office systems are robust for dealing with mail and reports

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