Documentation burnout is one of the most universal, least talked-about pressures in healthcare. It drains clinicians’ time, erodes patient connection, and follows providers home long after the last appointment ends. In episode three of Care Decoded, host Lucy Medina sits down with Dr. Sunil Nihalani, practicing physician and CEO of Inferscience, to break down why documentation fatigue has become such a crisis — and what the future looks like when technology actually supports clinicians instead of burdening them.
This recap pulls out the biggest insights from their conversation, highlighting the emotional, clinical, and financial impact of documentation challenges, and how AI-powered tools may finally offer a path forward.
When Lucy asks Sunil whether documentation has ever derailed his workflow, his answer is immediate — and familiar to every clinician.
Power outages, system downtime, slow internet, clunky EHRs… any disruption can stop care in its tracks. But even on normal days, the intrusion is constant.
Sunil describes clinicians who use headsets to dictate in real time:
“I have never heard a good thing from a patient about that.”
The bigger issue isn’t dramatic failures — it’s the slow erosion of trust and connection when a clinician is forced to focus on the screen rather than the patient. Most providers aren’t choosing to disengage. They’re simply overwhelmed by the documentation requirements embedded into every visit.
Sunil is one of the lucky ones — he can type without looking at the keyboard — but even then:
“The technology is too intrusive during the patient encounter.”
And patients feel it.
One of the most striking parts of the episode is Sunil’s explanation of how documentation shapes a clinician’s entire day — and night.
Studies consistently show providers spend more time documenting than speaking with patients. But Sunil adds context that data often misses:
Back-to-back visits leave no time to finish notes
Charts pile up
Documentation spills into evenings and weekends
Family life suffers
Mental load becomes constant
He gives the example of a friend — a gynecologist — who spent weekends catching up on charts instead of playing tennis for years.
“It affects family life, your interaction with your kids… there’s a big, big burden.”
The burnout isn’t just exhaustion. It’s the sense that the work follows you everywhere, growing faster than you can manage.
Lucy asks whether the real issue is technology or design philosophy. Sunil’s answer? Both.
Most EHRs weren’t built as documentation tools. They were add-ons to practice management systems — built by engineers, not clinicians.
“I don’t know how much usability went into the design.”
The result: multi-click workflows, clunky interfaces, and rigid structures that don’t reflect how clinicians think or work.
And because switching EHRs is expensive and operationally painful, many organizations stay locked into systems that drain productivity and morale.
When documentation tools don’t work, the ripple effects are far-reaching:
Incomplete notes disrupt care continuity
Referrals lack context
Primary care physicians receive unclear or missing updates
Patients repeat their stories because documentation didn’t capture the details
Care gets delayed or duplicated
Sunil describes cases where specialists spend little time documenting, forcing primary care providers to “guess” what happened or order new tests.
Incorrect or incomplete documentation affects billing
Poor support for diagnoses increases audit risk
Inadequate documentation triggers clawbacks
Government audits introduce additional penalties
Value-based care metrics suffer
“Either way you can get screwed, so to speak.”
Delayed documentation is expensive — not just in dollars, but in compliance exposure and inefficiency.
Sunil explains that retrospective coding has a structural flaw:
Coders only see what’s documented.
They cannot infer what happened.
They cannot repair missing context.
Two things go wrong:
Under-documentation → Lost revenue
If a specialist didn’t record key conditions, coders can’t capture them later.
Over-documentation → Audit risk
If coders extract diagnoses from incomplete notes, plans face exposure.
In both scenarios, care quality and financial performance suffer.
Despite the challenges, Sunil is optimistic. New tools — particularly AI-driven ones — are bringing meaningful improvements.
Tools that listen to encounters and generate draft notes are already making a difference.
Sunil recently adopted one in his own practice:
“It does a decent job of capturing the encounter, and I can edit it however I want.”
Ambient scribing:
Saves time
Reduces after-hours charting
Captures more natural patient narratives
Improves accuracy
Sunil believes AI will expand far beyond transcription:
Surfacing relevant labs or history during the visit
Highlighting risks
Suggesting guideline-based care
Reducing steps inside the EHR
Not as a replacement, but as a supplement — a clinical co-pilot.
This is one of Sunil’s most important ideas.
AI should feel like part of the experience — not another system to battle.
“It should give you signal, not noise.”
The best tools:
Don’t interrupt
Don’t require extra clicks
Offer insights precisely when relevant
Never force decisions
Reduce, not add, cognitive load
When AI is invisible, clinicians finally get time back.
Sunil outlines the “non-negotiables” for documentation technology:
Seamless usability
Accurate capture of conversations
Intelligent placement of information
Easy editing for clinicians
High reliability
Clear clinical value
Minimal false positives
Strong data integrity
But one principle rises above all:
“Design and usability should be number one.”
If a tool adds friction, clinicians won’t use it — and burnout grows.
One of the most personal moments in the episode comes when Sunil shares a story about interviewing a nurse practitioner.
She happened to work at a clinic that used Inferscience. She didn’t know Sunil helped build it.
When he asked about their documentation tools, she broke into a smile:
“This is fantastic. It’s really improved my life.”
For Sunil, that moment was grounding — a reminder that technology can meaningfully reduce burnout when designed with empathy.
Sunil ends the conversation with a hopeful message:
Interoperability is expanding.
EHR barriers are shrinking.
New players are prioritizing usability.
AI is becoming more supportive, not intrusive.
“There’s definitely a better future ahead — for documentation, and even for clinical decision support.”
Burnout may be real and widespread, but the industry is moving toward tools that respect clinicians’ time, expertise, and humanity.
Documentation burnout isn’t just a technology problem — it’s a human one. When tools interrupt the patient relationship, steal personal time, and compound financial risk, clinicians suffer on every level.
But the shift has begun.
AI-powered scribes, smart workflows, and better-designed systems are finally offering relief. If adopted thoughtfully, they can help clinicians spend less time clicking and more time caring — the way healthcare was always meant to function.
To hear the full conversation with Lucy and Dr. Nihalani, listen to episode 3 of Care Decoded, and share it with anyone who’s ever felt buried under the weight of documentation.
