The Clinical Informaticist and the Selling Out of Doctors

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I happen to be reading one of the throwaway journals I often get and came across some perplexing stuff.  In the January version of the Family Practice News I saw a picture of two happy doctors (Dr. Notte and Dr Skolnik).  They are often shown in this magazine because they do some writing for the rag.  And they are always happy, I guess. Anyway, the title of the piece was EHR Report: The scribe in the room and the scribe in the sky and it seems to extoll some of the virtues of today’s technology.   The article gently talks about “the necessity of data input into discrete fields in the chart” and “the need to efficiently and effectively input a large amount of information has presented perhaps the greatest challenge of going digital for many physicians”.  Uh…ya think? They then go on to talk about transcription software, medical scribes, and lastly, something I never heard of called Augmedix.  You are not going to believe this but this service has the physician wearing a small head-mounted computer that includes a microphone, camera, and transparent display. OMG!  Want more?  Here you go:

This allows visual and auditory data from the patient visit to be transmitted to a scribe (a real, live human) located remotely in one of Augmedix’s data centers. The scribe is “logged in” to a copy of the physician’s electronic record and documents the visit in the appropriate place in the chart. This occurs in real time, so when the physician is finished seeing the patient, the note is complete and ready to be signed off.

This is no joke.  Some dude in Indiana or India could be watching you do a pap smear and is supposedly just typing away and not sharing the pictures he is seeing.  Who is going to trust this?   Once again it shows how we doctors will do anything to change our way of practicing medicine but we will do NOTHING to fight back against those forces (the government, the insurers, administrators, etc) who are making us change and ruining the physician-patient relationship.

Now let’s talk about our smiling doctors.  They end their little education post with a kind of mission statement:

As for us, we are still typing our notes into the EHR, for now. We remain intrigued by the range of approaches that are beginning to appear, offering options for solutions that improve the quality of physicians’ lives with attention to maintaining and improving the physician-patient relationship.

Ahh, the old quality ruse.  These things improve the quality of physicians’ lives and improve the physician-patient relationship?  What world are these guys from?  Well, at the bottom it showed me:

Dr. Notte is a family physician and clinical informaticist for Abington (Pa.) Memorial Hospital. He is a partner in EHR Practice Consultants, a firm that aids physicians in adopting electronic health records. Dr. Skolnik is associate director of the family medicine residency program at Abington Memorial Hospital and professor of family and community medicine at Temple University in Philadelphia.

Yup, one of these guys is teaching our family docs in training and the other is a “clinical informaticist”.  What the hell is that?  Has anyone every called him on that name before?  He must have made that up.  And it sure is nice that he is a partner in a firm that aids doctors in adopting EHRs.  That sounds like very unbiased writing to me.  No wonder why he is smiling. What a bunch of crap.  Oh, I get it, that is why they call them throwaway journals.  Sorry. It took me a while.

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] 

  6 comments for “The Clinical Informaticist and the Selling Out of Doctors

  1. Robert D'Agostino, MD
    February 14, 2016 at 2:32 pm

    When these two consistently hammer the notion about how useful the EHR is, then their veracity must be questioned.

  2. Dan Dailey
    February 11, 2016 at 10:58 am

    How much of this have we brought on ourselves? I work both as one of your despised informaticists and a clinician in our outpatient clinic and hospital.I have lost count of the number of times I’ve gone over a chart with a patient and have been told that they were never asked a question or several on the review of systems that the physician entered as “normal”. Exams have been entered as normal that the patient again states were not performed. A few days ago, I was preparing to do a monofilament exam on a diabetic patient. The patient saw the monofilament and said, “I haven’t felt my feet in years!” Yet six months previously, his physician had documented a normal diabetic foot exam that explicitly included a monofilament examination. Cases like this are NOT rare. This is why the old joke that “WNL” stands for “We Never Looked” evolved and why there is always a bureaucrat or an insurance accountant looking over our shoulders.

    • Pat
      February 11, 2016 at 7:49 pm

      Dan, there is no doubt that a great many of the docs your are criticizing have cut-and-pasted erroneous data merely in an effort to keep up with the accelerating, ridiculous, often useless, usually redundant reams, piles, lists, and mountains of data that must be tabulated, documented, (now) scribed, collated, transmitted, accepted, and then believed in order to get freakin’ paid… if the stupid codes are right. I’m certain I have multiple times, albeit unwittingly. All of this data overload is made possible in great part by informaticists who profit by abetting the accelerated third-party control of all physicians. If that’s how you make a buck – let’s face it, it’s probably more fun than seeing patients these days – then fine. But I don’t think you should be on your paid high horse ragging on whipped physicians while promoting the hand holding the flog. Real primary care could be done on a 3X5 card per visit, but that would put too many of the ancillaries out of a job.

      Have we brought this on ourselves? You bet! By accepting the government coin for so long, the increased intrusions of third-party insurance and hospital companies, by not shutting the AMA, AAFP, et al down, by not going on damn strike, medicine has sold its soul to the bureaucrats looking over our shoulder, encouraged by your industry. To paraphrase Jeff Goldblum in “Jurassic Park”, you were so busy seeing if you ‘could’, you never stopped to think if you ‘should.’

  3. Steve O'
    February 10, 2016 at 8:23 am

    “Clinical informaticist” was invented because the sex industry workers’ union objected to the use of “corporate prostitute.” There are certain things that sex industry workers just won’t do.
    I have long predicted that by 2017, a video recording of the physician/patient encounter will become a permanent part of the medical record. The ungainly video-recorder headband/light has become barely noticeable, what with LED’s and minicams.
    The CPT/billing industry has been suspicious about whether people are asking questions about ALL of the fourteen systems’ review areas. Sometimes doctors may be shaving off a few of the 56 obligatory questions for 99215 billing. “Takes too much time!” is the feeble doctors’ excuse. Now, they can have video PROOF that you didn’t ask the patient ALL of the pertinent negative questions! And poof, there’s 15% savings on every $40 office visit, that’ll balance the budget!

    • Perry
      February 10, 2016 at 11:46 am

      Hey, I want to be a clinical Informata-thingy when I grow up…

    • Sir Lance-a-Lot
      February 10, 2016 at 3:08 pm

      I think “Clinical informaticist” is a highfalutin’ synonym for those things that you insert – you know – and, like, sometimes they vibrate and stuff…

      What was that word again?

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