Let's Talk Progress Notes
If you ask around about the aspects of clinical work that cause problems for therapists, you will probably find writing progress notes to be in the top 3.
Progress notes can be hard on clinicians for a variety of reasons:
- The emotional toll of the session causes you to avoid writing the note and experiencing it again.
- You don’t have a good system in place to make sure you are on top of your notes.
- You have ADHD (like me), and find it hard to get motivated to do mundane tasks.
- You are so far behind that overload and fear of an audit have you paralyzed.
- You feel insecure about what should be in the note and worry that you are not covering all of the bases.
- Your EHR or note-taking system is cumbersome so you avoid it.
If you fit into any of the 6 categories I have listed, read on for some tips to get caught up and stay caught up with your progress notes
- Emotional toll: this can be especially difficult for some niches, such as those that do work around trauma. Writing the note immediately after the session while you are still in that emotional headspace can be really helpful. Also consider doing conjoint notes where you right the note as the session occurs. Or you can leave time at the end to summarize the session with your client and write the note with them there.
- Need a good system: There’s nothing better than ending your work day knowing all of your notes have been written and you have filed your claims. One way of achieving this is by allowing 5 minutes between sessions to complete the note immediately. If you don’t have time for that, take a minute to jot down key words and quotes from the session to make it easier when you return to write the full note.
- AHDH: For those of us with ADHD brains, systems are probably a huge part of your life. Having a firm rule about when you write the note, and not allowing yourself to negotiate a different time, can be key to making note taking at the end of the session or by the end of the day can be really useful. You might also consider using voice to text input if your EHR has option.
- Too far behind: It happens to all of us every now and then. Whether you have too much on your plate due to the demand for mental health services due to the pandemic, or you were sick, or you have been having a hard time doing them in general, the most helpful thing to do is the stay current with your notes. If you have overdue notes from 2 weeks ago, write the notes for today and work your way back. Some EHRs will allow you to move from one note to the next so you can go back and do the missing notes easily.
- What should be in a note: Writing notes for liability reasons and insurance reimbursement can be very different than those you wrote at an agency or even in grad school. Do a little research. Each insurance panel will outline what needs to be in a progress note for reimbursement. Many EHRs have note templates that you can use and modify to make sure everything is covered. Consider taking an e-course by someone familiar with auditing cases so you can learn what you need to include. You might also learn some tips and short-cuts.
- Cumbersome EHR: The system you use should work for you and the way you practice. There are a number of choices of EHRs and testing out several to see which one works well with how you practice is important. What works for your colleague may not be a good fit for you.
A few more tips:
- Have a specific procedure written down that defines how and when you need to write a progress note. (Within 24 hours of session, prior to submitting the claim, etc)
- Work with a colleague. Many people find it easier to stay on task if they are working with someone else. For AHDH brains, we call this body-doubling. Set up a time to write notes with a colleague. Or have them be your accountability partner whom you can notify when you’ve completed your notes.
- Use the Pomodoro method to set aside uninterrupted, focused time to get them done.
- Set aside admin time each day so you will have uninterrupted time to get the damn things done!
If I have missed a category that causes you problems with keeping current with your progress notes, or you have a helpful tip to share, hit reply and let me know so we can learn from each other!