…a never-ending attack on the profession from government, insurance companies, and lawyers . . . progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.
I have done my share of complaining about electronic medical records (EMR), but in this case the blame is misplaced.
When a sick Liberian man walked into Texas Presbyterian Hospital last month, “Protocols were followed by both the physician and the nurses,” the hospital said in a statement released Thursday night.
The man told a nurse he had come from West Africa, where an Ebola epidemic is raging.
“However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case.”
The hospital said its electronic health records include “separate physician and nursing workflows.”
The hospital said the Liberian man’s travel history was located in the nurses’ portion of the EHR, but — “As designed, the travel history would not automatically appear in the physician’s standard workflow.”
Yes, EMR has turned doctors and nurses into data entry clerks, and has decreased face to face communication between members of the health care team. But you can’t blame this error on the EMR.
The physician is responsible for obtaining an appropriate medical history from each patient, including travel history and exposure history. I frequently see patients originally from Latin America, the Middle East, Central and Southeast Asia, and, yes, from Africa. Getting a travel history from these patients is always appropriate, and is the doctor’s responsibility, regardless of the nurse’s responsibility to enter it into the EMR.
One of the things I strive to teach my students and residents is “If you ask the right questions, the patient will tell you what is wrong with him.” In today’s technological world of medicine, no lab tests or imaging scans will replace performing a good history and physical examination.
I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.
Now is the time for physicians to say enough is enough.
Try implementing this! From Pat Conrad, MD at Authentic Medicine.
In the 3/1/14 issue of Family Practice News, an article caught my eye: “Physicians face steep ICD-10 price tag.” The article quotes heavily from that Vichy of health care, our beloved AMA, which funded an impact study through the Nachimson Advisors on the imminent ICD-10 switch. Staff training, new software/hardware, testing, crates of Maalox, and increased liquor bills are now all projected to be THREE TIMES higher than predicted in 2008. The firm hired by the AMA now estimates ICD-10 costs to range between $56,000 and $285,000 for – deep breath – small practices. By “small” they mean 2 to 3 physicians. “One reason for the increased cost is new requirements related to the adoption of EHR’s.” Nachimson also forecasts a disruption of 2%-6% of claims after 10/1/14.
This is a “crushing burden on physicians” according to AMA president Dr. Ardis Dee Hoven.
Now lean in close y’all, because I really want you to hear this statement without me typing it in all caps. Pres. Harden: ”Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve quality of care.”
Do you read that the way I do? What I hear this arrogant puppet saying is that the extra money extorted from physicians should not be, because it was otherwise going to be plowed back into whatever patient-centered-medical-home-texting-skyping-emailing-EHR-HIPPA compliance-culturally-competent-coordinated care crap the likes of her ilk could devise, for our own good. The statement makes very plain that she thought the $56-$285 K for a small practice would not be going into the doctor’s pocket, which is another way of saying, she didn’t think they really earned it anyway. Yo, Ardis! It’s our money!
Hat tip to Johnny Johnston, MD