While going through the latest stack of bills, I was just about to throw the usual stack of junk mail in the can when a line caught my eye: “Med students: Look up from your EMR’s”, a guest editorial in The Journal of Family Practice. So the journal doesn’t want students scope-locked on their computers, huh? I read on.
The author Jeffrey Unger, MD, wrote about his experience with acute appendicitis, and the grossly inadequate history and physical techniques on the part of the med students. Apparently the poor 4th-year assigned to the surgical rotation directed a lot more energy and attention to getting the right checks in the right boxes, than he did toward doing a complete exam. This crusty old FP of considerable experience would not let him leave the bedside, and kept directing him to the items he missed. Of course Dr. Unger also wanted his feet examined, because he is a long-standing diabetic – and specializes in treating diabetes, and has published textbooks on diabetic management – and also demanded the student ask him what his most recent HgBA1c was, and whether he had had any long-term microvascular complications (I guess when you always carry a hammer…). Dr. Unger was concerned that the student didn’t check him for peritoneal signs, and also wanted his eyes and mouth checked. Angry at this point, he recalled, “The student was more interested in inputting data into the EMR than learning about acute abdomens and type I diabetes.” The doctor-patient later complained about the attendings trying to remove his insulin pump until his wife fired them, started directing his own IV therapy, and laments that had he not been an experienced FP he would likely have suffered a fatal post-operative event.
Dr. Unger states that in his practice he only uses an EMR to e-prescribe, has chosen not to participate in submitting meaningful use data to the government, otherwise takes all his “notes on scratch paper” (not sure what he does with those later), and brags: “I only order tests to confirm a suspected diagnosis, not as a primary means of evaluating patients.”
And isn’t that the kind of doc we thought we were trained to be? Unger’s last thought was that med students unplug their smart phones, and train with “old-time docs who still work with their hands…rather than texting and data entry. We’ll show these students how to become caring, intelligent, and dedicated clinicians.”
But cynical bastard that I am, I suspect that the various insurance companies do not accept his notes on scratch paper. Dr. Unger is 62, graduated from med school in 1980, and from residency in 1983. According to Healthgrades.com, he accepts Aetna, Cigna, Blue Cross, and various other PPO’s and HMO’s. Beside his picture it says he is the director of a “Concierge Medical Group.” Does this mean DPC? I don’t know. I also note that for all his eyeballs-and-fingertips bedside exam advocacy, Unger’s website also advertises telemedicine consultations in Nevada and California.
What I’m left with is the suspicion that, despite his laudable comments, Unger is a member of a medical generation and primary care establishment that does not take responsibility for what they created. They want the med student to be a great clinician, yet they have supported those institutions that now force him to waste time on non-clinical garbage. My suspicion is that the ones complaining are the very same who have grown that mushroom.Tweet