“I Know I’ve Seen This Before”: How Information Scatter Drives Clinician Burnout
The first post in our Information Chaos series
As a primary care physician, I often find myself saying, “I know I’ve seen this before.” A lab result, a symptom, a family history note. It’s somewhere in the chart—but not where I need it, and not when I need it. That moment of uncertainty, repeated again and again throughout the day, isn’t just a minor inconvenience. It’s a symptom of a deeper, systemic flaw in how we manage medical information. That flaw has a name: information scatter.
What is information scatter?
Beasley et al. described five dimensions of information chaos in primary care, and scatter is one of the most damaging, and most fixable. Information scatter happens when relevant clinical data is present, but spread across multiple disconnected places in the chart. You know it when you see it:
A lipoma mentioned in a faxed radiology report and progress note but not added to the problem list
A medication change noted in a secure message, never reflected in the med list
Anxiety symptoms discussed in an old HPI, then re-mentioned in a follow-up note with slightly different language
A colonoscopy result buried in a scanned PDF with an out-of-date care gap
In theory, the information exists, but in practice, it’s fragmented. Unfortunately, it’s up to the clinician to reassemble the story from scratch.
Why scatter leads to burnout
At first glance, scatter may seem like a minor UX issue. But across a full day of patient care, its effects are cumulative—and corrosive.
Cognitive overload: Your brain spends energy stitching together fragments instead of solving problems.
Redocumentation: You rephrase the same info repeatedly in different parts of the chart, just to ensure it doesn’t get lost.
Increased error risk: Important clinical details are easier to overlook or contradict across encounters.
Mistrust in the record: Over time, clinicians start treating the chart as a rough draft, not a source of truth.
Moral injury: The disconnect between good clinical thinking and broken systems creates guilt, frustration, and disillusionment.
Scatter doesn’t just waste time—it erodes confidence, drains attention, and turns documentation into a burden rather than a tool.
The Stream approach: Fight scatter with structure
At River Records, we designed Stream to solve this. Stream is a problem-oriented AI scribe that listens to the patient encounter and organizes documentation around persistent clinical issues, not visit-based templates. That means:
When something new is discussed—like a mass, anxiety symptoms, or a med change—it’s threaded to the correct problem automatically
You can update existing problems over time, instead of rewriting the story each visit
Everything you’ve already said is available and organized—not buried across past notes or inbox threads
Stream isn’t just faster—it’s better aligned with how clinicians think, and that makes documentation feel less like a chore, and more like a continuation of clinical reasoning.
Scatter is optional. Burnout doesn’t have to be inevitable.
This post is the first in our series on information chaos in medicine. Each post will explore one dimension of the problem and how it contributes to clinician burnout—and how thoughtful system design can help. Because we believe better documentation isn’t just about speed or billing. It’s about clarity, continuity, and care.
Want to see what it’s like to work without scatter?
