How Can We Make Time for Empathic Clinician-Patient Interaction?

Primary care is one of the most rewarding areas of medicine. We spend our days providing care across the spectrum of health and illness, developing relationships with families, managing chronic conditions, and catching and addressing early signs of trouble. The relationships built with children and their families, as well as with our colleagues in care, are the main things creating meaning and satisfaction in our work. But the administrative demands of the job, separate from our interaction with patients, have taken over at least 65% of our time; and visit times in pediatrics average less than 11 minutes.

Electronic health records, intended to improve communication and continuity, have instead taken over our evenings and weekends. Many of us now spend more time clicking than connecting. The term “pajama time” has become a familiar shorthand for those late-night hours we devote to finishing charts, long after our patients have gone home. The toll this takes isn’t just logistical—it’s emotional and physical, and it’s wearing us down.

Of course, we know that documentation is essential. It is needed for patient safety, continuity of care, to meet regulatory requirements, and to secure the billing we earned and depend on. But the volume and complexity of the data we’re expected to collect and record have exploded. Even with removal of required data for review of systems and counts of documentation components for billing, visits still demand a detailed history, medication reconciliation, counseling notes, billing codes, and follow-up plans. And while we’re doing that, we’re also navigating EHRs that certainly weren’t designed with clinicians in mind.

This documentation burden doesn’t just consume time—it can interfere with quality of the care we provide. When our attention is divided between our patient and a screen, something gets lost. We miss cues, reduce eye contact, and may end up with a sense that the visit was more rushed than we intended. As a result, we may wonder if we listened as empathically as we wanted.  Patients are more likely to stay under our care and to follow a plan we negotiate with them when they feel that we know them and care about them and empathic listening is key.

For many of us, this erosion of connection is one of the most demoralizing parts of this changed workflow. Although somewhat lower since the peak of the pandemic, 48% of primary care clinicians report symptoms of burnout, and the most frequently cited cause is excessive time spent on documentation.

So what can we do? One thing potentially under our control is streamlining the way we document. Templates and macros, when thoughtfully created and personalized, can significantly reduce the time we spend repeating the same phrases or formatting information. It’s worth investing time to customize these tools for common visit types, health supervision, follow-ups, some chronic conditions, so they serve us rather than slow us down. Studies have shown that implementing customized EHR templates can decrease time spent on documentation and increase provider satisfaction. But we still need to be sure there is enough information specific to this patient and encounter for us to keep relevant details in mind in formulating and carrying out the plan, being able to notices changes in functioning, and to ask about at the next visit to show that we care.

Delegation may also be possible for some documentation. Medical assistants or nurses can gather collateral information from teachers or specialists, score developmental or mental health screenings (if not automated), and assist with pre-authorizations or appeal letters. Artificial intelligence (Ai) can even incorporate a summary of IEP plans, report cards, etc. into a draft of a note.  With clear protocols and training, these real and “virtual team members” can take on essential tasks that don’t require us, freeing time for the parts of care only we can provide.

In some practices, hiring scribes has been transformative. Whether in-person or virtual, a good scribe allows you to engage fully in conversation without worrying about capturing every detail in real time. For those of us who enjoy teaching, it’s worth noting that scribe roles are often filled by students with future plans in healthcare, making it a mutually beneficial setup. Research shows that scribes can reduce documentation time by up to 50% and improve clinician satisfaction.

We’ve all had days (weeks?, months?) where the charting just piles up, and it can feel like we’ll never catch up. Some clinicians have successfully scheduled (if we still have agency) or insisted on dedicated, protected blocks of time during the workweek for documentation. It’s important that this time is not treated as availability to squeeze in extra visits, but as a paid time as essential to our functioning as any patient encounter.

We can also rethink how we collect information. Patients and families are mostly very capable of providing histories and completing screenings ahead of time. When we set up processes for pre-visit questionnaires to be completed as a routine, we walk into the exam room with much of the groundwork already done.  We can then spend more of the visit focused on the patient’s priorities, rather than asking routine or rule out questions, and know what to delve into that the patient (or the parent of a teen) may not have even realized was a possible issue that was revealed by a screen. Not only does this save time, but pre-visit questionnaires also allow patients to share more candidly—especially when the questions involve sensitive issues which have been shown to be more completely reported to a questionnaire than an in-person history. Instead of manually entering answers or retyping handwritten information from the parent, we can review, edit, and incorporate pre-visit content that meets our needs and satisfies billing requirements.

While technology has often been part of the problem, it can also be part of the solution. New “ambient” scribes using Ai such as Corti, Nuance, DAX, Heidi, Suki, etc. do an amazing job of recording our conversations and observations during the visit and even presenting it in various formats of notes within minutes. Corti can even optionally score the empathy shown in the exchanges recorded and provide feedback for us to improve. 

Of course, this technology only records what is said, requiring either asking everything aloud (and in front of anyone in the room, including the child), or adding notes after the visit. Tools that allow patients to enter their own data, that automate scoring and interpretation of screens, and that generate structured documentation combined with an Ai scribe system (for example, CHADIS) means visit priorities and topics not requiring further discussion can be taken into account from the start of the visit. The structured data from both the validated questionnaires and clinician entries that can be prompted from linked decision support at the moment of care constitute guideline-based data that are essential to creating the ideal “learning health system” specific to pediatrics that is needed as the future of care and personalized medicine.

In some practices, the effect of adopting these strategies has been profound. Clinicians have reported saving several hours a day, and drastically reducing pajama time and practice feels more manageable again. With less time spent on documentation, there’s more for empathic listening, shared decision making with families, follow-up, collaboration, and the kind of longitudinal care that drew us to primary care in the first place.

Reclaiming our time isn’t just about efficiency—it’s about restoring pleasure in medicine. We entered this field to connect, to listen, to heal through our relationships, not just our diagnosis and prescribing actions. When documentation demands squeeze those values, we suffer—and so do our patients. With the right strategies, a collaborative team, and smart use of technology, we can save time, reduce stress, and return to the heart of what we do best.

DR. HOWARD is the creator of CHADIS (www.CHADIS.com). She had no
other relevant disclosures. Dr. Howard’s contribution to this publication was as a paid
expert to Elsevier. E-mail her at pdnews@elsevier.com.