The Hidden “Deep Work” of Medicine: Why Your Inbox Is More Demanding Than It Looks

For many physicians, the electronic health record (EHR) inbox is considered “light work.” It’s necessary but unrewarded. The only metric that matters is whether it gets done within a prescribed time frame.

A closer look reveals more depth: A message from a worried patient. A lab result that’s a little bit off. A radiology report that raises more questions. A preauthorization for a needed test. They’re important and necessary, but something you’re expected to squeeze in between patients, or finish at the end of the day.

Let’s be clear: It’s not light work when you

⚕️take the time and mental energy to thoughtfully review a complex lab trend

⚕️interpret an imaging report in context of the past medical history and recent symptoms

⚕️advocate for your patient with a persuasive argument to a nameless utilization review auditor

⚕️respond to a nuanced message

In many cases, it’s exactly what productivity expert Cal Newport would call deep work.

What Is “Deep Work”—and Why Does It Matter in Healthcare

Cal Newport describes deep work as cognitively demanding high-value work that requires sustained focus, careful thinking, and meaningful decision-making.

Many inbox tasks fit the definition of deep work. They may be considered task completion, but in reality it’s clinical decision-making. And this work often requires the same level of focus as seeing a patient face-to-face.

The Hidden Cost: Attention, Energy, and Time

One of my recent coaching clients—a highly skilled subspecialist—put it perfectly: “It’s not only the volume, which is a lot. It’s the work of thinking.”

Patients are complicated human beings. Decisions about their care are rarely binary, and small, easily overlooked details can change management. Reviewing the chart, searching out records from the hospital or outside sources, and responding to a patient’s concerns takes time and mental energy.

Because inbox work is not formally structured into the clinical day, it often gets pushed to the margins. That usually means between visits, during lunch, at the end of the day, or at home, late at night.

One physician I know gets up in the middle of the night to work on his charts, because it’s the only time he can work without interruptions.

It’s easy to see how these strategies can lead to cognitive fatigue and even burnout. Increased risk of errors, an anxiety-producing sense of always falling behind, and difficulty feeling finished at the end of the day are natural consequences of a perpetually replenishing inbox.

This physician-level work largely goes uncompensated. But because it happens in small, fragmented pieces, it’s easy for both institutions, and physicians themselves, to underestimate its true impact.

The Mismatch: Deep Work in a Fragmented Environment

According to Cal Newport, deep work requires:

🔺Focus

🔺Time

🔺Continuity

But the typical clinical environment offers:

🔻Interruptions

🔻Time pressure

🔻Constant task switching

This mismatch is at the heart of why inbox work feels so draining, and why it can be a driver of moral distress. You’re being asked to do cognitively demanding work in conditions that actively undermine your ability to do it well.

A Call to Healthcare Leaders

If we continue to treat inbox work as administrative overflow, we will continue to underestimate its impact on physician capacity, decision-making, and patient care.

It’s time to take a closer look:

⭕ How much cognitively complex work is being done outside of scheduled hours?

⭕ How often are physicians expected to perform deep clinical thinking in fragmented time?

⭕ How can this work be fairly compensated?

⭕ How can tasks be pre-screened and delegated to other qualified staff members when appropriate?

Instead of relying on physicians to absorb this work at any cost, how can systems better support them in doing it well?

Providing the time and space for deep work in all its forms is essential for both physician sustainability and high-quality patient care.

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Master Your EHR: Proven Strategies to Take Back Your Time

I still remember my first day in clinic as a cardiology attending. I was eager, definitely a little nervous, and determined to provide the best care possible to my new patients.

Back then, we were still using paper charts. They were far from perfect, but in hindsight, those analog files had their advantages—no endless clicks, no after-hours inbox, just a straightforward way to document and move on. But I digress.

That day, one of my more seasoned colleagues pulled me aside and gave me a piece of advice that, over time, became ever more valuable:

"Whatever you do, don’t let your charts get out of control."

At the time, I didn’t fully grasp the weight of his words. But it didn’t take long to understand.

Fast-forward to today, and the electronic health record (EHR) dominates medical practice. It’s here to stay, but it comes at a cost. A study of over 200,000 EPIC users found that physicians spend nearly six hours in the EHR for every eight hours of patient care. That’s almost an entire workday devoted to documentation, order entry, inbox management, and other digital tasks.

While awareness of this issue is growing, and new tools are emerging to help, the reality is clear: the EHR will continue to demand a significant share of your time and attention. You may not be able to escape it, but you can take control of it. The key is to be intentional about the way you use your time.

Six Essential Strategies to Keep Your EHR Under Control

Here are six key strategies that have helped me, and many of my clients, take control of the EHR. I hope they’ll help you do the same, freeing up more time for what matters most.

Make a Plan And Stick with It

Your EHR workflow should be intentional. Whether it’s blocking dedicated time for documentation, setting clear start and stop times, or batching tasks, having a structured plan prevents endless charting after hours.

While you can’t control every aspect of your day, deciding in advance when and where you will complete documentation keeps you on track.

Minimize Task Switching

It’s tempting to juggle patient care, inbox messages, and documentation all at once, but constant switching fragments your attention and slows you down. This is what is known as attention residue.

Instead of struggling to do everything at once, try to dedicate specific blocks of time for notes, messages, and testing review. Batch similar tasks together, even if you’re only spending 15 minutes on them.

When possible, set clear expectations with your staff and patients about response times to minimize interruptions. You might also include setting a defined limit on the number of back-and-forth messages you exchange with patients. After a specified number within a given time frame, consider if an office visit or tele-visit is required.

Setting aside time to tackle your in-basket before or after clinic can also make a big difference. When you handle these tasks during these quieter times, you’re less likely to get interrupted. You’ll also be protecting your time at home. Even a focused 30 minutes per day will help you to stay on track while lessening the impact of work on your personal life.

Use Smart Phrases and Macros

Most EHR systems allow you to create shortcuts for frequently used phrases, reducing typing and dictation time and improving efficiency. Develop smart phrases for common explanations, patient instructions, and standard findings to streamline your workflow without sacrificing quality.

If you have access to a “super user”, or an EHR specialist, make use of them. These individuals can help you navigate the fine points of your EHR and make your work more efficient.

Make Templates Work for You

Templates are invaluable for structuring your notes efficiently. Whether you modify existing ones or create your own, templates ensure consistency, save time, and reduce cognitive overload. By having a template, your notes will make sense and you’ll ensure nothing is left out.

Keep in mind that a good template should be readable, relevant, and concise. No one benefits from pages of repetitive text or unnecessary jargon. And since patients have access to your notes, including unclear verbiage can trigger more messages in your inbox.

Create a Problem List

One important aspect of your EHR strategy is an accurate and updatable problem list. By keeping the list complete and up to date, you will save yourself untold hours of frustration. That’s because repeatedly scrolling through a chart trying to cobble together a current history is a waste of precious time, both during office visits and when trying to put test results into context.

When you use a well-curated problem list, you’ll also inspire greater confidence. When you have all the relevant information at your fingertips, it will be clear to your patients that you are up to date on their health concerns, testing, and any surgeries or procedures.

An important caveat: you can’t always depend on the EHR to generate a factual or relevant problem list. This is something that may require some work on the front end.

Explore AI and Automation

If your EHR offers AI-powered documentation tools, voice recognition software, or automation features, consider incorporating them into your workflow. While technology won’t solve every issue, it can significantly reduce time spent typing and organizing information.

Just be mindful that AI isn’t perfect, and it’s no substitute for clinical judgment or personal attention. Always review its output carefully before sending it out into the world with your signature.

Take Back Your Time

EHR-related burnout is real, but it isn’t inevitable. By implementing simple, consistent strategies, you can regain control over your documentation.

You’ll free up valuable time for patient care and enhance your professional fulfillment and joy. Plus, you’ll break free from the cycle of late-night charting, creating more space for rest and balance. Instead of feeling tied to your screen, you’ll have more time to recharge and be present for yourself and for the people that matter most to you.

What strategies have helped you manage your EHR workload? Drop me a note. I’d love to hear from you!

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary coaching discovery meeting, click the button below.