Letting Patients Write in the EMR

Here is a brilliant concept from the Ivory Tower researchers.  A few of them have decided to blow the medical chart wide open! They figured let’s let EVERYONE put stuff in there. For those that don’t know, it used to be just the doctor who wrote in the medical chart but all the new bogus regulations made it necessary to have medical assistants, front staff and scribes doing their thing in there as well.  So what’s next?  Patients!  These researchers decided it would be awesome to let them “type their agenda into their clinic note before a visit”.  Seems simple, right?  Uh..no.  Even as a DPC doc I don’t think I have time for this.  Anyway, in this study, “a research assistant met with patients in the waiting room, provided them with a laptop with the clinic’s EHR interface, and let them type their agenda.”  So, one more staff person to hire.  You can afford that, right?  That doesn’t matter to researchers because they don’t live in the real world.

Now the sneaky fun stuff.  “The patient’s agenda remained in the notes section of the permanent visit record, adjacent to the physician’s note, in the EHR.”  Can anyone else see a malpractice attorney licking his chops going through old patient charts to find some small irrelevant complaint of abdominal pain ten years ago in a colon cancer case?  One where the patient refused screenings but the lawyer now says YOU missed the abdominal pain?  Case closed.

In the end the “patients and clinicians agreed that the agendas improved patient-clinician communication” and it may “enhance care by engaging patients and giving clinicians an efficient way to prioritize patients’ concerns, noted the researchers.”

C’mon.  Really?  Let’s find some real answers to improving care instead of creating new problems.

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 “Letting Patients Write in the EMR

  1. Dick Carlson
    March 18, 2017 at 2:42 pm

    I understand your concerns — sounds like a whole lot of extra work.

    But I will tell you that of my last dozen doctors, maybe ONE of them actually bothered to read the details on why I was in his office. And that guy glossed over or ignored something so he could run out of the office to his next patient.

    After I’ve waited two hours in your office for you to see me, that’s not gonna fly.

    • Pat
      March 18, 2017 at 2:59 pm

      Doug, I think you’ve found your next DPC patient!

    • Doug Farrago
      March 18, 2017 at 4:09 pm

      I am not defending the present and broken system. You need a direct primary care doctor. Go to http://www.dpcfrontier.com and look at the mapper. Find one and join one.

  2. Pat
    March 18, 2017 at 1:30 pm

    Maybe clinicians should have patients enter the ENTIRE chart, so they can see just how efficient and how much fun EMR’s are…of course that would take so long, the office would lose even more money.

  3. March 18, 2017 at 10:35 am

    I love this. But with an adaptation. I’m in my doctor’s exam room. He is typing and asking me questions. I have a laptop and type in my answers. No words are spoken.

    • Randy
      March 19, 2017 at 12:07 pm

      I think you have a great future in medical administration.

      • March 19, 2017 at 1:14 pm


  4. Randy
    March 18, 2017 at 8:15 am

    I think there is value in better identifying the patients major concerns. The trouble is often they don’t come in and say “I’m worried I’m having a heart attack”, “I’m worried I have cancer”, etc. You have to dig a little deeper and pick through the extraneous stuff.

    So the question is does the patient writing their own agenda improve communication? The study didn’t really measure any outcomes, they just surveyed the patients and doctors. I could make the case it might be better to actually let the patient talk and look at them as opposed to reading their notes.

    • Steve O'
      March 18, 2017 at 11:17 am

      Having the burden of e-mail communications already with patients, I believe that it will be a disaster. The way that one ascertains the differential diagnosis of chest pain is with either a skilled interview with a professional, or parking someone in an ER for 12 hours for a “rule-out.”
      As the role of the physician in the medical visit becomes more like a clerk fetching items for a shopping list, the ER supplants the clinic office. When someone tweets you – “Chest Pain – BAD!” and you are expected to reply, the only decent reply is “Go To ER!”
      I have had patients furious at my differential diagnosis. Possibilities of anxiety or somatization mentioned in the chart can be met with “Prove it!” or “See you in court!!”
      What happens is the inevitable outcome of mismanaged big data – piles of worthless words entered for the purpose of entering something about the visit. If they want oatmeal, they get oatmeal.
      In the ancient days, the hospitalization of a 25 year old female for an uncomplicated pyelonephritis might engage five to ten pages; but all of those contained vital information. As the need to “document everything” arose, and the purpose of the chart withered away, everyone had to “chart” and nobody had to “read.” I expect that the medical chart will soon be ignored entirely, and all information gleaned from the patient without wading through the verbiage stuffed in there from everyone, including the patient.
      I had a patient hospitalized for a complication after surgery – a DVT. It was missed, and I suspect that occurred because everyone had their mind on the chart, nobody had their mind on the patient. I worked it up after release, and put him on anticoagulant. My interest conveyed to the patient was the consequence that he might have a dangerous clot remaining. I am not a lawyer – I do not know if a medical diagnosis was missed due to deficient practice. Who screwed up is not my problem – the patient could pursue the matter, and chose just to ream out the surgeon who did the surgery, which was his choice.
      I am bothered because from what the patient told me, everyone was charting and nobody was thinking. Anybody can chart. It’s the thinking that matters.

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