Drivel by Ted Bacharach MD (retired)
Henry Wadsworth Longfellow
“There’s nothing in this world so sweet as love. And next to love the sweetest thing is hate.”
In the realm of love and hate the thing that bears out this sentiment better than all others is the “computer”. PC, MAC or any other operating system, the computer engenders strong but divergent opinions on almost every day. I am not sure how this affects other professions but for the physician this relationship becomes very apparent. Even on days when he or she is not working the computer is revered or reviled each day, although perhaps not quite as often as on a work day.
The physician has become wedded to the computer for better or worse, a sentiment we share. The patient’s medical record, his history, physical examinations, laboratory and X-ray findings are all recorded. Since the advent of Medicare and insurance physicians have tried to justify their charges by increasing the length of their records. The x-ray once pronounced as being *normal* is now described in detail and in some cases even the abnormality which may be the main reason for the examination is missed. History and physicals are given considerable verbiage and in many cases once something is in the record it is perpetuated even though it may be wrong. In the case of my wife, one physician many years ago stated she had had a hysterectomy, although this was not true it was recorded the same way on many physicals after this.
During a recent visit to a physician I noted that he spent far more time looking at my medical record than on any history or physical examination, I guess he thought that whatever someone before him had done and recorded it must be accurate.
The insurance companies have also had a problem with computer generated medical records. If you ever applied for insurance or a loan there was a small print section that authorized the company access to your medical records. Recently the length of the medical records has made it difficult for the person reviewing the record to understand all of it. A mistaken diagnosis can be perpetuated forever.
The computer records make the interchange of information simple and extremely valuable but not without some problems.
In view of all of the above drivel, I think it is still a good idea to talk to your patient, examine him and add your findings to that invaluable medical computer record.
After all is said and done there is still another computer problem that adds to our frustration and that is the “password*, which can make all things difficult..
… and if patients only knew how many non-physicians had access to their medical info….
Dr. Bacharach, I was a medical transcriptionist for many years. I quit in 2005 because of job burnout & now run an informational website for healthcare professionals.
With all due respect, you have no idea what medical transcriptionists go through, especially those who work for a transcription agency & are paid by the line, character, or some other metric. Because of the constant need to save keystrokes, which equals saving time, every transcriptionist has hundreds, if not thousands, of short forms for medical phrases encoded in software. Thus an expansion error like “porta hepatitis” for “porta hepatis” will pass unnoticed through the spellchecker & probably into the final report. And there are soundalike drug names, ambiguous abbreviations, horrible dictators … some transcriptionists are willing to stop typing to look up a word, but many won’t.
Some patients think they have the right, not just to a correct medical record, but to control every single thing it says. My own mother didn’t like it when her doctor listed hypertension in her medical record – for which she has been taking several medications for the last 20 years. I explained very carefully that, even though her blood pressure now is somewhere around 110/70, her underlying hypertension is the justification for the antihypertensive medications. Once she understood that, she was fine with it.
Nice points all, Ted. I work in 5 different rural hospitals, two of which have electronic ordering, and all of which are (of course) forcibly moving to EHRs. The two that are already computerized ae markedly slower in an environment where appropriate expedition is as critical as the other clinical skills. Yet with the lousy bait-and-switch coercion of Medicare bonuses, we are now moving slower, and with at least as much if not more chance for error. As usual, the politicians were happy to demand more work for the same money, and as usual the AMA ultimately worked to harm physicians.
These systems are one of the reasons I now refer to hospitals as “health care factories,” with all of the sad and horrible imagery intended. M