My “Love Affair” With Computers by Aaron Levine MD

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Why I like paper:

I have patients, especially the older ones, who complain to me that they do not like my staring at a computer and talking to them. They prefer eye contact. One of the hospitals I belong to had a meeting a few months ago about improving our grades. One suggestion is learning how to use the computers without looking at the screen. I am not sure how to check boxes when I do not know where the cursor is. I was “encouraged” to purchase my office computer a few years back via one hospital’s physician organization. They included all the necessary grades to include the quality measurement criteria (PQRS). I just got my report card and found that I am only 14% participating. The criteria they chose for me are not those of my specialty, so I did not do them. There goes the 2% penalty from the government. I just got back from a meeting on hospital computers. The issue is that when someone goes from rehab to the acute side for a test or workup, they will be discharged and then readmitted. This satisfies the IT department as the only way it can work. However, this means we will have a ton of same day or next day readmissions and this looks lousy on quality.

I used to write admitting orders on paper and place them in a drawer. The nurses would open the drawer and start the orders. They would call me if there were any changes or inconsistencies (which may occur after I write orders and then the patient is discharged later). Now, I cannot write orders on the patients until they are officially admitted or preadmitted. Sometimes they are the same. In theory, I can write my orders remotely with the computer. In fact, often the computer in my home will not allow me access to the chart. The other hospital requires a special encryption in my computer. Therefore, I cannot write orders sometimes at night, or at a different hospital, etc, or shopping, etc. I may drive back and forth between 2 hospitals (35 miles apart) 2 or 3 times a day and at night (had to do this after midnight once, and then got dinged that it was not done on the same date that the patient arrived). Other times, the orders were accidentally deleted and I have to reenter by computer.   I gather this is somehow more efficient than using pen and paper. I wonder if I argue that the gas I used (which is expensive) is increasing my carbon foot print and for environmental reasons I should go back to paper. Then again, I probably would be told to get an electric car to go with the EHR.

Lastly, rehab is a small specialty. My call group goes back 20 years with coverage at multiple hospitals. Each has a different computer system. Now that we are paperless, none of my call group will cover me as they do not want to learn another computer system for a few days, and then forget it over the year. The hospital will not let me have them cover until they show competency and take a day off from their practices to train.  So I am required to go to a meeting but may not have coverage.

On the flip side, there were problems reading my handwriting, but I solved this by typing my orders before putting them in a drawer.

Now before anyone links me with the Unibomber, I took basic computer training as a premed in the 60s. I foresaw the role of computers but not to the extent that occurred.  I believe in telling the emperor he has no clothes. My wife feels I am just a misanthrope. She said, teachers have gone through this already, and we should face it that doctor means “teacher”.

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]

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2 Responses

  1. GSalard says:

    Dr. Levine, I could not agree more! In my practice I we are forced to use two different EHRs — the clinic’s and the hospital’s — which do not communicate with each other. Although EHRs are good at retrieving data (notwithstanding the caveat of “garbage in, garbage out”), it takes time to put the data in. Instead of having my note completed by the time the patient leaves the room, it now takes an extra 5 minutes to close everything out, assuming I don’t have to order labs, referrals, etc. The hospital’s EHR was obviously the cheapest they could find. It now takes 2-4x longer to admit most patients. No longer can I write an order to initiate a medication with instructions for stepwise increase in dose up to a maximum (i.e., 5mg QD x 3 days, then 5mg BID x 3 days, then 5mg TID, etc.). Now I must write an order for each dosing, with start and stop dates for each. And this is a simple example. And don’t forget those lab results that are electronically put into your “que” to sign off on. There is not paper copy to write instructions to your assistant to call the patient or mail the results, etc. More time out of my day taking care of administrative work instead of seeing patients. I am so close to leaving Family Medicine and going back to full-time Emergency Medicine where my time off is not spent catching up on EHR charts. What will it take for us to finally say, “Enough!”

  2. Les says:

    BRAVO! As a patient, my primary care doc brings my “chart” into the exam room, and as we discuss what’s ailing me (or maybe it’s just the annual physical), I have his full attention. [email protected] we finish the (usually) 15-minute appointment, he takes a few minutes to actually WRITE what transpired. His office does have computers, of course, and there is pressure from his group to “go paperless,” I know he resists it based on conversations we have had. When I have been examined by another physician who tap-tap-taps on a keyboard while we’re talking, I cannot escape thinking that maybe he’s writing to a girlfriend or his mother. My veterinarian, on the other hand, will examine my dog and dictate notes to his vet tech, who’s at the computer. I – and my dog – have his full attention, and he doesn’t have top mess with IT until he reviews my dog’s chart.

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