I want to talk about FMLA paperwork, which is not a sentence I ever imagined writing on this blog, but here we are. If you have practiced primary care for any meaningful length of time, you know the feeling I am about to describe. A patient asks during the visit if you can fill out a form for them, and you say yes because of course you say yes, and then the form lives in your inbox or on your desk for the next three weeks while you tell yourself you will get to it on Sunday, and then Sunday comes and you do not get to it, and by the time you finally sit down to do it the patient has already called twice to ask where it is.
FMLA forms are the worst of these. There are eight pages, much of it duplicative, and the questions are written in the kind of careful legal language that requires you to read the same sentence three times before you understand whether it wants a yes or a no. The information they want is technically all in the chart, but it is scattered across a dozen visits and lab results and specialist notes, and assembling it into the precise format the form demands takes me about forty minutes per patient if I am being honest. Forty minutes, for which I bill almost nothing, on a Sunday I would rather be spending with James.
Last week I had three FMLA requests pile up. One was a postpartum patient I have known since her pregnancy. One was a patient with rheumatoid arthritis who was starting a new biologic and needed intermittent leave for infusions. The third was a patient I have been treating for major depressive disorder, who had finally agreed with me that she needed a short medical leave to stabilize on a new medication regimen. I dreaded all three. I am being honest about that because I think we pretend doctors do not have feelings about paperwork, and we do, and the feeling is usually a quiet sense of being slowly suffocated.
Sunday morning I made coffee, sat down at my laptop, and opened the chart for my postpartum patient first because she was the most overdue. I clicked on the FMLA form template, and the EMR asked me a question I was not expecting. It asked, would you like me to draft this from the chart and you can review and edit. I sat there with my coffee getting cold and read the prompt three times. I knew, in some abstract way, that Hero had been adding features to handle long-form administrative documents. I had not yet tried them. I clicked yes, mostly out of curiosity, and went to refill my coffee.
When I came back, the form was filled out. All eight pages. The dates of the relevant pregnancy and delivery were pulled correctly from the obstetric note. The expected duration of the recovery period was filled in based on the typical postpartum guidance and the patient's specific clinical course, which the system had clearly summarized from the chart. The section about whether the condition is chronic or episodic had a coherent answer with a note that I could revise based on my clinical judgment. The certifying physician fields had my name, my NPI, my license number, and the practice address. The signature line was blank, waiting for me. The whole thing read like something a thoughtful colleague had drafted for my review, not like an autofill that had stuffed values into fields.
I read the entire document carefully because I trust this software a lot and I still wanted to make sure I was not signing something I did not mean. I changed two sentences. One was a phrasing preference about the description of essential job functions, where I wanted to be a little more specific. The other was a date range I wanted to extend by two weeks based on a conversation we had at the most recent visit that I remembered but the system had not weighted heavily. The whole review took me eleven minutes. I signed it, and the system queued it to be sent through the patient portal with a note letting her know it was complete and what to expect next.
Then I did the second one. The rheumatoid arthritis patient with the new biologic. This one was more complicated because the leave was intermittent and the form has a separate section about the unpredictability of episodes. The system handled the intermittent leave portion in a way I had not seen before, drawing on the documented frequency of flares and the planned infusion schedule and writing a coherent narrative about why the patient needed flexibility. I edited more of this one than the first, mostly because I wanted to soften the language in a few places, but the structure was right and the clinical facts were right. Eighteen minutes total.
The third one was the depression case, and I want to spend a paragraph on this because it is the one that most changed how I think about this technology. Mental health FMLA paperwork is in some ways the hardest to write because the form is built around physical illness and you have to translate the realities of a psychiatric condition into language the form can hold without flattening the patient's experience into something dehumanizing. The draft the system produced for this patient was careful in a way I did not expect. It used appropriate clinical language without diagnostic stigma, it described functional impairment in terms of specific work tasks, and it did not over-share details that the employer did not need. Whoever designed the prompts that drive this feature thought about it, and you could feel that they had thought about it. I edited the assessment of expected duration, which is always an educated guess in these cases, and then I signed it. Twenty-two minutes total because I was reading carefully.
So three FMLA forms in fifty-one minutes, including the part where I was making coffee and questioning my life choices. That is roughly two hours less than I would have spent on these on a typical Sunday. I want to be clear that I did not just rubber-stamp anything. I read every page of every form, I edited substantively where I disagreed with the draft, and I signed nothing I did not believe. The system handled the assembly, not the judgment. The judgment was still mine.
What surprised me most was how I felt afterward. I had braced myself for the Sunday-afternoon paperwork dread, and then the dread did not arrive. I closed the laptop at ten thirty in the morning and went outside with James and we walked to the farmers market and bought too many strawberries. I kept thinking about it on the walk. Not in a giddy way, because I am too tired for giddy these days, but in the quieter way I think about things that have actually changed my life. The FMLA backlog has been a small black weight in my chest for three years, and on Sunday it disappeared, and I am still adjusting to its absence.
The technology is not magic. It does not know my patient the way I know my patient, and the parts I edited were the parts where my knowledge mattered more than the chart's knowledge. I do not want to overstate this and have someone read this post and think the EMR is going to practice medicine on its own. It is not. But the part of my job that was a tax on my Sundays for the last decade, the assembling of clinical facts into the precise format that some bureaucratic form demands, that part the technology can do, and it can do it well enough that I am willing to trust it as a first draft.
I have been thinking about why this matters more than the actual time savings, which are real but not the main thing. The main thing is that I dread these forms less, which means I say yes to them more quickly, which means my patients get them faster, which means a postpartum mother gets her job protection paperwork in two days instead of three weeks, and a patient on a new biologic does not have to call twice to ask where her form is, and a woman who finally agreed to take a medical leave for her depression does not lose her nerve in the time it took me to write the certification. The time savings is for me. The faster turnaround is for them. I have come to think those are not the same thing, even though they look like they are.
I am going to go through my form backlog this week, and I am going to write about how that goes if it is interesting. I am also going to keep paying attention to what these long-form administrative features can and cannot do, because I think we are at the early edge of something that is going to change primary care in ways I cannot yet predict. For tonight, I am going to go finish those strawberries. James is making something with them and the kitchen smells like June, and I have nothing to do tomorrow before clinic except show up.