Drowning in Documentation: The Cognitive Overload of Clinical Notes
A Day in the Life (of a Drained Doctor)
Dr. Patel sits at her desk long after clinic hours, the glow of the EHR screen illuminating her tired face. She scrolls through endless patient notes, lab results, and auto-populated templates. Her mind feels jammed. After seeing a full day of patients, she’s spending her evening clicking checkboxes and sifting through old notes to make sure nothing important is missed. This mental exhaustion she feels isn’t just “a long day”—it’s a classic case of cognitive overload in clinical documentation.
What Is Cognitive Overload in Clinical Documentation?
Cognitive overload occurs when the brain’s capacity to process information is exceeded by the sheer volume or complexity of data. In plain terms, it’s like your working memory’s circuit breaker tripping from too many inputs at once. In Dr. Patel’s case, juggling a patient’s history, current complaints, past labs, and the EHR’s documentation requirements all at the same time overwhelms her mental bandwidth. Research shows that when clinicians face excessive information in the EHR, it can impair decision-making and increase stress (integratedcarejournal.com). It’s relatable to any doctor who has tried to recall a critical detail while drowning in a sea of data. No wonder so many independent physicians feel mentally fatigued by day’s end – their EHR is constantly testing the limits of human attention.
How Today’s EHR Design Fuels Mental Fatigue
Unfortunately, many current EHRs seem designed to exhaust clinicians. Dr. Patel’s EHR requires her to navigate multiple tabs and pop-up alerts just to get a full picture of one patient. This fragmented design means she’s clicking in and out of different screens for medications, past notes, labs, and images, which shatters her focus. Studies have found that poorly designed user interfaces and cumbersome workflows in EHR systems exacerbate cognitive load. Every extra click, every irrelevant alert, and every hunting expedition for information adds to the mental burden. Frequent pop-ups (for drug interactions, reminders, etc.) that intend to help can instead cause alert fatigue – doctors become desensitized and might miss truly critical warnings (integratedcarejournal.com). In short, today’s EHR fragmented design forces clinicians to multitask and remember too much at once, leading to slower workflows and slip-ups in decision-making. By 5 PM, the interface has sapped as much energy as the actual practice of medicine.
Note Bloat, Copy-Paste Culture, and the Signal-to-Noise Problem
Adding to the strain is the overdocumentation that has become the norm in clinical practice. Take Dr. Patel’s patient notes: each note is several pages long, packed with templated text and copied-forward information from prior visits. This “note bloat” is not just her style—it’s a systemic issue. Our analysis of millions of notes found half of all words in a typical clinical note were copied and pasted from previous documentation (ama-assn.org). In fact, the prevalence of duplicated text in notes grew from about one-third of the content in 2015 to over half by 2020 (ama-assn.org). As AMA researcher Dr. Christine Sinsky described, there’s now a huge amount of “sludge” in the system – meaning extra fluff like over documentation and note bloat that clinicians must wade through (ama-assn.org). We have a copy-paste culture driven by time pressure and billing demands, where the same assessment plan, review of systems, or boilerplate text gets cloned forward endlessly.
The result is a poor signal-to-noise ratio in the chart. The important clinical signals (the one new finding, the critical lab result, the true assessment of today’s visit) are buried in a mountain of old, redundant information. For someone like Dr. Patel trying to quickly pick out what changed with her patient, this is a nightmare. In our research, we have noted that all this duplicated content “provides no new information” yet increases the time required for the next clinician to figure out what’s accurate or relevant (riverrecords.ai). Overwhelmed by bloated records, even a diligent doctor can miss key details hidden in the noise (ama-assn.org). In practical terms, that might mean overlooking a subtle change in a lab trend or a critical note from another specialist, simply because it’s lost in the clutter. Templates, meant to speed up documentation, often end up contributing to this clutter as well – injecting lengthy default text that isn’t always tailored to the patient. All of these factors make it harder for clinicians to see what truly matters in the patient’s story.
📊 Our research: over 100 million notes, half duplicated.
In our peer-reviewed study of 100+ million clinical notes, we found that more than 50% of the words were duplicated from prior documentation. It’s not just a nuisance—it’s a fundamental design flaw in how clinical notes are structured today.
Read the full study →
Why This Matters: From Burnout to Bottom Line
Cognitive overload from documentation isn’t just a headache for clinicians—it has broad implications for healthcare operations and outcomes. Here are a few major consequences:
Reduced Efficiency: Time spent wrestling with the EHR is time taken away from patients. For every hour of direct patient care, doctors spend nearly two additional hours on EHR and desk work during the clinic day (ama-assn.org). All the extra clicks and needless documentation slow down workflows, meaning fewer patients can be seen. It’s not surprising that 80% of physicians say excessive documentation time directly impedes patient care (medicaleconomics.com).
Clinician Burnout: The mental fatigue and frustration from documentation overload is a known driver of burnout. Regular cognitive overload is a major risk factor for clinician burnout. Physicians who own their practice feel this personally – it’s draining to finish charts late at night (“pajama time”) and come back the next morning already exhausted. Over half of clinicians in some surveys report symptoms of burnout, and this is tightly linked to the onerous documentation burden they face (integratedcarejournal.com). Burned-out providers often experience demoralization and may cut down their hours or even leave practice, which only further strains healthcare access.
Lost Revenue: For independent practices and MSOs alike, time is money. When physicians are tied up documenting, they’re seeing fewer patients. Every hour spent on paperwork is essentially an hour of billable patient care lost. Inefficient workflows also mean delays in coding and billing – mistakes in overstuffed documentation can lead to claim denials or slower reimbursement, hitting the practice’s bottom line. In other words, “time wasted on inefficiencies is money lost” (physiciansangels.com). Additionally, burnout-fueled turnover comes with hefty costs for recruiting and training replacements. For MSO decision-makers, documentation overload isn’t just a clinician problem; it’s a business risk that can erode profitability.
Degraded Patient Care: Perhaps most importantly, patient care suffers when doctors are overloaded. If Dr. Patel is charting at her computer, that’s less attention on the patient in front of her. Documentation demands can impair real-time communication, as clinicians focus on forms instead of eye contact. Moreover, critical information can fall through the cracks of an overwhelmed mind or a cluttered chart. Alert fatigue, as mentioned, means true warnings might be overlooked (integratedcarejournal.com). And when physicians are burned out or rushing, errors are more likely. In a national survey, four out of five doctors admitted that heavy documentation requirements harm patient care (medicaleconomics.com). Fragmented notes can lead to fragmented understanding of the patient, potentially resulting in misdiagnoses or delayed treatments. In short, when clinicians can’t easily see the forest for the trees in the medical record, the patient’s health is at stake.
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Envisioning Better: Documentation that Supports Clinical Thinking
It’s not all doom and gloom—there is a growing recognition that clinical documentation can be reimagined. What might it look like if notes and EHRs were redesigned to truly support how clinicians think?
Imagine if Dr. Patel’s documentation system worked with her cognitive flow instead of against it. Important information would rise to the top: the latest critical labs, the key developments since the last visit, the active problems – all summarized clearly (with the option to drill down for details). The interface could be streamlined so that instead of 10 clicks to find a detail, maybe it’s just one or two, or even zero because the system intelligently presents the data in context. In an ideal world, the EHR would present “just what you need, just when you need it,” minimizing extraneous noise. Perhaps the note would be more of a living story of the patient, not a repetitive form. Clinicians wouldn’t feel the need to copy-paste large blocks of text, because the system itself would maintain a cohesive narrative of the patient over time.
Automation would play a helpful role in this future. Routine elements of documentation (like vitals, medication lists, past history) could be pulled in automatically behind the scenes, without the physician having to manually re-enter or verify them at every visit. Voice recognition or digital scribes could capture the physician-patient conversation in real time, structuring it into a concise note so that Dr. Patel isn’t typing much at all. (No specific product needed – it’s the concept of freeing the doctor from the keyboard.) Decision support could be embedded gently: for example, if Dr. Patel is assessing chest pain, the system might unobtrusively highlight the relevant risk factors and guidelines, supporting her clinical reasoning instead of interrupting it. The overarching idea is a documentation process that augments the clinician’s thinking rather than disrupting it.
For the operational leaders at MSOs, this vision translates to happier, more productive physicians and better outcomes. Clinicians with intuitive, supportive documentation tools can see patients more efficiently and spend more of their energy on care rather than clerical tasks. Overload would be replaced by focus. Instead of dozens of pages of boilerplate, a redesigned note might be a lean synopsis with high relevance – improving the signal-to-noise ratio dramatically. Such a system could reduce errors (because nothing important gets buried) and reduce burnout (because doctors can actually leave the office on time). It’s a future where documentation is not a dreaded after-hours chore but a seamless part of patient care.
Conclusion: A Path Forward
Dr. Patel’s story is all too familiar, but it doesn’t have to be the status quo forever. Recognizing cognitive overload in clinical documentation is the first step toward change. By acknowledging how current EHR designs and documentation habits are overwhelming our clinicians, both frontline practitioners and healthcare leaders can rally for improvements. Independent practice owners can push for workflows and templates that cut the clutter, and MSO decision-makers can prioritize technologies that mitigate mental fatigue rather than compound it. The end goal? An environment where doctors end their day feeling thoughtful and effective, not drained and defeated. If we design our documentation systems to truly support clinical thinking, we can reclaim time, reduce burnout, and most importantly, improve patient care – all while maintaining a healthy practice. It’s a vision worth striving for, and each incremental fix moves us closer to documentation that heals instead of harms.
Sources:
Integrated Care Journal – EHRs and Cognitive Overload - integratedcarejournal.comintegratedcarejournal.comintegratedcarejournal.com
AMA (JAMA Network Open study) – Duplicated Text and Note Bloat in EHRs - ama-assn.orgama-assn.orgama-assn.org
AMA (Time Allocation Study) – Physician Time on EHR vs. Patient Care - ama-assn.org
Medical Economics – Survey on Documentation Burden Impeding Care - medicaleconomics.com
Physicians Angels – Hidden Costs of Documentation Overload - physiciansangels.comphysiciansangels.com
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