Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ken Fisher, MD, who is an internist/nephrologist in Kalamazoo, Michigan, a teacher, author ("Understanding Healthcare: A Historical Perspective") and co-founder of Michigan Chapter Free Market Medicine Association. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
There has been much published in both the medical and lay press about the magnitude of errors in medicine. This is a contentious subject with wildly variable results most likely due to the difficulties associated with the many and varied complexities of clinical medicine.
Medical errors certainly exist and we should be diligent in trying to completely eliminate them. While knowing that, as with any human enterprise, perfection should be the ultimate goal even though it is most unlikely.
But what constitutes a style of medical practice that minimizes the chances of medical errors?
A close, truthful and thoughtful relationship of adequate time and focused attention with the patient is the best way to avoid medical errors—a situation where the physician has the time to illicit a careful history providing clues to the actual pathophysiology. The physician then needs time to integrate this information into a coherent conceptualization of the issues at hand, a thoughtful differential diagnosis and a rational plan. At this point the physician can order specific tests to further document the actual pathophysiology.
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This careful process also fosters the development of a beneficial therapeutic relationship between patient and physician whereby the physician can advise and the patient follows through on a various number of issues aimed at maximizing the patient’s physical and mental health. In this way, unnecessary testing is eliminated, chasing false leads with its inherent problems does not occur while medicine becomes as error-free as humanly possible.
However, what is the reality of today’s patient-physician relationship? The picture is the opposite of what was just described as high quality medical practice. Recently, there was a published study (Ann Intern Med 2016; 165: 753-760) following physician time spent on direct clinical face time with patients versus time with the electronic health record (EHR) and administrative tasks.
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According to the findings, for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day. Outside office hours, physicians spend another one to two hours of personal time each night doing computer and other clerical work.
These expanded clerical requirements have had a serious negative impact on the actual time physicians have with patients, thereby compromising care.
In essence, instead of being able to focus their energies on their patients, physicians have been converted into data entry clerks because of ill-advised Congressional actions, primarily the HITECH Act and the Medicare Access and Chip Reauthorization (MACRA) Act.
Making matters worse, the information demanded by these laws is neither rigorous nor based on the scientific method, making the usefulness of this robust data accumulation grossly exaggerated. Thus, the process of skillful medicine as described does not take place, the patient-physician therapeutic relationship is being destroyed, medical errors are bound to increase, patients suffer and physician malcontent is increasing.
It is inescapable that our Congress, by enacting HITECH and MACRA, demonstrated that they have no understanding of the complexities involved in caring for patients. Their misguided obsession of collecting relatively useless data at the expense of patient care makes our Congress the major source of medical errors in the United States.