She Moved Countries. The Charting Problem Followed | Episode 193

Dr. Sarah Smith recently joined Dr. Andrea Austin on Heartline: Changemaking in Healthcare to talk about something that hits close to home for a lot of doctors: the charting problem that follows you no matter where you work, what system you're in, or what country you move to.

In this conversation, Dr. Smith shares practical emergency department charting strategies, her honest take on perfectionism and training trauma, and why the administrative burden is an "us problem, not a you problem."

This episode originally aired on Heartline: Changemaking in Healthcare, hosted by Dr. Andrea Austin, board-certified emergency doctor and doctor development coach. Visit andreaaustinmd.com to learn more.

Timestamped Highlights

[02:00]: Dr. Smith traces how she became interested in helping other doctors, starting with 15 years of working evenings and weekends before she finally figured out how to get home with the work done, and what it took to get there.

[07:00]: The emergency department gets specific attention here. Dr. Smith explains why doctors staying six hours after their shift is not a personal failing, and what it is actually costing the department.

[09:00]: A quick shift huddle at the start of every shift, done right, can reduce interruptions, improve teamwork, and set up the whole team to leave closer to on time. The logistics are simpler than you might think.

[11:00]: Real-time charting in a busy ED sounds impossible. Dr. Smith makes the case for why doing it imperfectly in the moment beats doing it perfectly at midnight.

[14:00]: C-minus. That is the charting standard Dr. Smith recommends when you are under pressure, and the reasoning behind it will resonate with anyone who has ever held their notes accountable to a voice from residency they do not even respect anymore.

[19:00]: Training trauma is real, and it shows up in documentation. Dr. Smith and Dr. Austin talk about the attendings, the fear of courtrooms, and the invisible audience doctors are still writing for years later.

[25:00]: What can a CMO or hospital leader actually do? Dr. Smith gives concrete, practical answers including one idea for how a department could restructure a shift to give doctors a protected hour to get caught up.

[31:00]: Dr. Smith lived and worked in both Australia and Canada, saw up to 40 patients a day across multiple practice settings, and was still working evenings and weekends in both countries. The problems followed her. What finally changed things was not the system; it was the skill set.

[39:00]: What does a sustainable clinical career actually look like? Dr. Smith closes with her own definition, and why the goal of leaving 10 minutes after the last patient once felt completely impossible.

Three Key Takeaways

1. The end-of-shift backlog is a system problem, not a personal one.

When doctors are staying six hours past their last patient to finish documentation, that is not a sign that those doctors are slow or disorganized. The electronic medical record was not designed for speed or ease, the click burden is heavy, and nobody hands clinicians the specific strategies to work differently inside it. Dr. Smith frames it plainly: this is an us problem, not a you problem, and that reframe matters because it puts the conversation where it belongs, at the level of the team and the department, not the individual.

2. Perfectionism around charting is often training trauma wearing a professional mask.

C-minus charting is not a shortcut. It is the right standard for a doctor who has not eaten in three hours, has a full waiting room, and knows something is coming through the door in five seconds. The reason so many doctors cannot let themselves chart to that standard is that they are still writing for an attending who intimidated them in residency, or bracing for a courtroom that is unlikely to ever materialize. Naming who you are imagining looking at your notes is one of the most practically useful things in this episode.

3. Moving countries does not fix the problem; changing your skill set does.

Dr. Smith left Australia for Canada and kept working evenings and weekends. Different system, different EMR, different patient volume structure, same problem. What changed things was not geography. It was learning a different way to interact with the system she was already in. For any doctor who is convinced their burnout is entirely environmental, this is worth sitting with: the system is broken, and it is also true that there is a skill set available that can make where you are right now more sustainable.

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