Posted on 02/09/2018 5:39:27 AM PST by spintreebob
My pediatric practice is one that harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated "hunt and peck" to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has not changed in almost five decades. I would not have it any other way.
This past spring, he walked into my office shaking his head in disbelief after thumbing through a stack of faxes.
"Can you believe this 16-page emergency room note has no helpful information about the patient?"
This was not a shock to me. The future of medicine will include robots who are paid to collect reams of useless data to provide nothing in the way of health or care. Regardless, the government and third-party payors will extol upon the virtues of their inept system as life expectancy falls.
Fifty years ago, there was a close relationship between a physician and their patient grounded in years of familiarity. Physicians took a history, performed a physical exam, and developed an assessment and plan. Diagnosis in a child with fever would be descriptive, like bacterial infection, otitis media, fever of unknown cause, or viral illness. Parents were advised to provide supportive care, involving clear liquids, fever medication, and follow up precautions if the child worsened.
At the dawn of the technological age, the effortless simplicity previously existing between physicians and patients has all but evaporated. It was traded away without our consent, relegating the role of physician to that of a data-entry clerk. Physicians are discouraged from synthesizing information and utilizing it to guide our decision making. Today, a 16-page document "appears" to contain crucial elements such as chief complaint, past medical and surgical history, medication list, and allergies. However, the information is then followed by more than a dozen pages of waste.
The particular case to which my father was referring involved a 5-year-old child with fever. The provider documented the sexual history of this child, whether he was single or married, and whether or not he had children of his own. My dad and I started chuckling as we contemplated collecting this kind of extraneous information from a child who had not even entered puberty. As one would suspect, our young patient was single, as in not married; he had no children (which is physiologically impossible), and his years of formal education were noted: "not pertinent to his medical situation." Interestingly enough, I volunteer at the school where this young boy attended kindergarten; his classroom was next door to the one with my second oldest child. Three of his classmates were out with febrile illnesses. However, technology cannot incorporate this kind of alternative data.
We kept reading and laughing. Occupational history was recorded as not on file; running a bustling lemonade stand in his neighborhood apparently was not clinically relevant. It came as quite a relief that at the tender and impressionable age of 5, this boy had managed to steer clear of regularly smoking cigarettes. It was comforting to discover he had never used smokeless tobacco either. And for some reason, I never thought to inquire about such things before (insert eye roll). He also denied alcohol use, restoring my faith in the fact that not every youngster was consuming alcohol during their formative childhood years.
Just when I thought things could not get more absurd, I came upon the sexual history; contemplating whether or not a five-year-old child was engaging in consensual intercourse was nauseating. I reminded myself that data entry clerks were devoid of emotion and instead were tasked with collecting "critical" details to practice by protocol. Sexual history: Not on file.
The final summary and diagnosis section was the most entertaining part, which read: "primary diagnosis: none." Seriously, are you kidding me? No diagnosis? This is the future; technology will seal the fate of our profession as one entirely devoid of the need for any cognitive skills. This earth-shattering conclusion after 16 (!) pages of documentation was utterly astonishing. Despite the considerable time and effort invested asking a febrile five-year-old whether he was married or having consensual sexual intercourse in his spare time, little to nothing was provided in regard to healthcare.
At this point, my father and I laughed so hard that tears were running down our cheeks. There is no other reasonable response to the sheer waste of time, resources, and education invested in becoming a physician. Doctors have spent decades honing their clinical skills and should be entitled to choose the documentation method they find most effective and efficient. Some physicians find electronic records helpful and should be encouraged to use them. My pediatric practice will keep surviving on a shoestring, a prayer, and good old-fashioned paper. It warms my heart to know each chart note contains helpful information and not one human being leaves with "none" as their diagnosis.
Footnote: Page 16 states, "This chart is intended to document the majority of the information from this patient's visit today. Other items, such as the patient's care timeline, are reported elsewhere and should be reviewed to better understand this encounter." (More eye rolling.)
By all means, if 16 pages did not cut it, twenty more should make sense of arriving at no diagnosis. Forgive me for not running out and requesting those records immediately.
Very true, I’m old enough to remember when you did house calls, though that was at the end of the era of that practice.
Now we have to fear FDA approve meds as much as we do incompent or under educated practioners. I resent a APN trying to Play ENDO, GASTRO, and NEUROLIGIST and counter what they advise, that is not there Education level or experience. And you don’t send a multi health patient who sees 4 main line Specialist to a APN for a Primary because you are to CHEAP to hire another Internist when 2 leave a 3 person practice, you just promoted the APN instead. Time to look for a new Internist practice. Technically they run blood labs and keep scripts the Specialist write currentas not to waste a Specialist time for a script renewal and routine small medical issues.
It has been quite an experience to see things change. When I was in Med School our Clinical Med professor was a fat old German who went to Med School in Germany during WWII. He insisted that clinical medicine did not require any labs or radiology studies. A clinical physician could make any diagnosis with the tools attached to his body, hands, eyes, ears, etc. and the most powerful tool was the one between the ears. I fear today medical students learn only who to order tests and follow algorithms.
The surgeons I learned from were maestros of skill and Michaelangelos in flesh. Their skill produced results today’s technicians cant emulate because today we produce technicians who can only reproduce “average” results.
A primary reason doc are going with concierge services us to escape the ObamaCare regulations.
I am loving the concierge doc I have.
*For a definition of off-label use of drugs read here: https://en.m.wikipedia.org/wiki/Off-label_use
relegating the role of physician to that of a data-entry clerk.
My neurology professor railed that the CT would ruin clinical neurology.
He was right.
He was a former Chetnik and hated the Left with a passion. Told us horror stories of the Communist takeover of Yugoslavia .
I had a numerology professor that could walk in the room and casually chat with a patient for 5 minutes and walk out and tell you exactly where the lesion was. The patients never knew they had been “examined”.
Actually, faxes are used quite frequently in healthcare. Even if you have an EMR, it doesn’t communicate with another EMR if they have different software.
You are wrong. Most physicians hate EMR. This was forced on the medical community by Bush.
The only good that comes from EMR is ability to access imaging and labs.That is, if everyone has the same EMR that can communicate with each other. Since different practices and hospitals purchase different software programs, that is not always the case.
“You are wrong. Most physicians hate EMR”
Bush didn’t decide on the content of the EMR.
People within the medical establishment decided on that. They could have created an EMR consisting of a blank page with the ability to add attachments and a few other things. They could have given the physicians the freedom to put anything they want into the EMR. They could have assumed the physicians would do a good job without guidance.
As a practical matter, certain requirements would make sense such as giving the codes for the procedures they perform.
The medical industry which includes practicing physicians, the insurance companies and all the rest have created a gravy train for themselves with outrageous costs to patients. If you want to complain about a bureaucratic mess, don’t forget that you made it, and don’t forget to enjoy those fat paychecks.
You have no idea what you are talking about. The cost of a EMR is in the millions, which made physicians have to merge with hospitals because they could not afford it.
The EMRs were created by tech companies with minimal input by physicians. EPIC is one company with the biggest share of the EMR market. No matter how much input medical personnel give EPIC in my organization, it still is a clunky mess.
You are an ignorant person, Medical records are much more than a blank page with attachments. They require: orders, labs, future orders, allergies, vital signs , past and future office visits, procedures, billing, nurses notes etc. Hundreds of details that you have no idea of.
Take your jealousy and go back to your trailer park.
“You have no idea what you are talking about.”
It’s possible that, in Bob Dylan’s words, “you’re right from your side and I’m right from mine”.
I’m sometimes a patient. You sound like you’re in the medical industry.
As a patient I see totally outrageous costs (you can’t deny that) and doctors whining about paperwork while getting big paychecks.
You say medical records are much more than a blank page with attachments. I didn’t say that. You simply put down a carelessly incorrect thought.
I said why can’t a medical record be whatever a doctor wants to put in it? Doctors go to medical school for at least six years and see thousands of patients. Shouldn’t they know what to say about a patient after seeing them?
If EMRs (actually, the EMR requirements) were created by tech companies with minimal input by physicians, why weren’t the physicians, as the ones who will produce the EMR content, paying more attention?
My family doctor told me once that he can see a patient and run some tests and pretty much know his condition. Could it be that the monstrous EMR requirements are mainly for lawyers?
Tell me this. When was the last time that the cost to the patient of a medical procedure, drug, or device was reduced?
Physicians don’t like the paperwork but they’re paid too much to be motivated to change the system.
By the way, overall I like America’s medical system but costs need to be brought down. Those inside the medical system will fight cost reductions tooth and nail. This is a tough problem for us deplorables.
The EHR Stimulus: A Complete Primer
This was was on Barry's watch. This funded the bribes to physicians.
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