Good luck with that --- all depends on residency attendings and how incompetent they are -- I've found an inverse relationship with the competency of the attendings and the amount of unimportant minutiae required in the note. But I digress --- dot phrases work, get a template with a basic physical exam that you realistically do (not the one you feel like you should be doing to be a complete and thorough physician but the basic minimum you do on all hospitalized/clinic patients) and roll from there -- the H&P is always a beast but put the time in on those -- the first progress note can be time consuming but after that, copy it forward, and change the details --- but beware -- some attendings will look back over previous notes, detect the copying and pitch a hissy fit --- most of us who are realistic are more interested in you knowing your patients, getting the essential elements of information needed and after you have demonstrated that you actually know what to do for a thorough H&P and we trust you enough to trim the fat, are ok with streamlining things ----
Case in point ---
One attending of mine wanted the history section in a very specific order and actually commented on it in my review --- I really, personally, don't care what order you put them but evidently, Western democracy as we knew it depended on it being in a certain order.
Another attending, when I tried to deliver the level of nit-noy detail the previous attending wanted, turned to me, stopped me in mid sentence and said,"C'mon, let's be reasonable here -- just give me the facts".
Best one ever -- working with a community attending who admitted his patient's to the teaching hospital and let the residents manage them with daily phone contact and he would round PRN to check up on us ---nicest guy ever, kind that still wore suits to the hospital; anyway, we were going to d/c a patient of his and he told us he would do the discharge summary and not to worry about it; I read it a few days later --- handwritten in fountain pen in the chart -- gist of it -- patient admitted for this, we did this, discharged home in this condition with this follow up -- see the chart if more detail required -- maybe 3-4 sentence paragraph --- that's the way it's supposed to be done -- not all this crap that no one reads anyway;
As a community physician, I have had 1, only 1, patient present within a week for hospital f/u that there was ever a d/c summary done on and the first paragraph and the f/u was all I was interested in.....
clinic notes just suck in general -- mainly used as a tool to justify a billing level, rather than containing any useful information......