All You Need Is More Help


I got a laugh out of John Hickner, MD who is the Editor-in-Chief of The Journal of Family Practice.   He wrote an editorial in response to his last editorial where he defended EMRs.  He describes how you can prosper with an EMR by having “someone else do most of the data entry.”  This is what he describes as “team care”, which typically involves assigning at least 2 medical assistants (MAs) to each physician, along with an RN or LPN whose time is often divided among 2 or 3 doctors.   Really?  What team is that?  The NY Yankees?  Hickner goes on to say that all you need to do is make an MA serve as a scribe and have her update the patient’s medical history and enter presenting symptoms in the EMR before the physician even enters the room. “The MA remains in the room while the physician examines the patient, entering orders and physical findings, and remains there after the physician is done to close the visit, issue instructions, and ensure that the patient has the prescriptions or orders for tests that he or she needs.”  Okay, so where do you get this extra MA?  He doesn’t say but explains that if you had one it would free up the 2 to 3 hours per day that the EMRs added to your workload of doctors.   Someone needs to tell the good doctor that most employed docs don’t get these luxuries and self-employed doctors can’t afford them.   What a bozo.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “All You Need Is More Help

  1. Burton Mendel, PA-C
    June 10, 2013 at 10:39 pm

    Not to mention, it doesn’t work. Our pain management practice already uses this system and what I’ve found is that , even though the EMR takes her by the hand and walks her through the history process, our MA still does not get the kind of details in her history that we need. You see, taking an adequate history is not part of an MA’s training!

  2. Ray
    June 9, 2013 at 8:14 pm

    The bureaucratic drag continues to accumulate. It used to be the doctor and maybe a nurse. Now it is the office manager/administrator, the coder, the PA, the NP, the MA, the dietician, the prescription medication liaison, the triage nurse, the lab person, the receptionist, the billing people, the tech support people, the layers of middle management that do nothing, the quality assurance people, risk management, did I mention the middle management people that do nothing but go to meetings and dream up… B#llshit!. It makes you wonder how health care got more expensive? Are you kidding me? We need to lean up as a health care system and a nation.

  3. simple simon
    June 8, 2013 at 8:28 pm

    Okay, do I get this right? This guy has MA’s who are smart enough to complete a medical-legal document with not much training beyond high school. Send me their names, and I will offer to pay them a dollar more an hour, and this doctor will be on his own like the rest of us. Where do you find well trained MA’s that don’t write in text messages? If they are that smart, they probably figured out how to embezzle from the practice with nobody the wiser.

  4. June 5, 2013 at 4:12 pm

    I am in solo practice. Like Dr. Grobman, I do everything myself. The EMR that I use is adequate for my needs to obtain data for clinical research. I have no damn interest in CMS, the government and organized medicine’s PIA regulations and concerns.

    In the words of the midwest philosopher, “What turnip truck did you fall off from?”
    Hickner needs to get back to reality. I wonder what his take on ICD10 will be when implemented.
    I am sure he a big fan of OBAMACARE and believes it will solve the health care issues in this country.
    His logic is as good as Jay Carney’s.

  5. Jerry Mazza
    June 5, 2013 at 1:02 pm

    That is why our office is not going with EMR. We have also stopped taking any new Medicare patients due to the EMT requirement. If the docs would just stick together, we might have some leverage. If all the doctors stoppped taking new Medicare patients, if even a third of us did, there would be so many complaints from the senior citizens, that the government would be forced to reverse the mandate.

    • Pat
      June 5, 2013 at 4:10 pm

      Right on!

  6. Darby Hand, DO
    June 5, 2013 at 11:34 am

    I work in state goverment. I am frequently involved in arbitrations which for the most part involve work related injuries. I have access to complete medical records becuase in such cases HIPPA does not apply. The majority of what I see anymore are EMR print outs. I have seen records where in the documentation of the injury and the physical findings are written as “normal” even in the cases of a legitimate work related injury. Take for instance the case of an examination for low back pain. I geuss the “drop down list” does not have all of the necessary choices in it and the resulting documentation looks something like “Back – spasm present. No hematoma. No echymosis. Reflexes normal”. Nothing else is written!

    At the arbitration hearing I can testify that the exam was documented as really normal becuase of what the documenation is namely not much. In those cases we win. Fortunately I will not ever have the EMR to deal with becuase we are exempt from whatever madate there is requiring practices to have the EMR. So……… least in this case I find some use for them.

  7. Pat
    June 5, 2013 at 10:12 am

    What a jerk. That 2 or 3 hours added to the day by EMR’s is a damnable mandate forced upon me from someone who does not do, and probably could never do, my job. One rural ER where I work has now slowed to a crawl because of this stupid system, increasing the time the patient spends in the ER by well over 100% for the most trivial complaint. The nurses are all constantly busy, typing garbage on to screens. And don’t blame this admittedly crappy EMR; it was rush-bought by a hospital on a tight margin that needed every government bonus it could get, and whose CEO felt appropriately pressured to do whatever it took. Thanks to idiots who want government to provide care, we have good nurses wasting their time on keyboards instead of at the bedside.

    Hickner can bleat about teamwork all he wants, but that doesn’t apply well when the team owner has the force of law with which to put you out of business if you don’t follow his most stupid whims.

  8. Marc Grobman, DO
    June 5, 2013 at 9:20 am

    To me all this EMR talk really pushes assembly-line medicine. Let’s do it like Ford or GM. Oh wait we are not putting together cars we are dealing with human beings with all their intricacies and idiosyncracies (and idiocies). I have been using an EMR, PracticeFusion, for the past 18 months with nary a problem (for free!!). I bring the patient back, take the vitals, examine the patient, develop the plan and write all the Rx’s as well as provide the education. It’s all me baby. I believe in the personal touch. I even do most of the prior authorizations! I can’t afford an MA let alone desire one to do my work for me. Let’s bring the physicians in the Ivory Towers down to the front lines.

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