How I learned to love my EHR and spend more time with patients

January 10, 2017

One of my favorite consultants is an orthopedist. His reports consist of five lines or less.

One of my favorite consultants is an orthopedist. His reports consist of five lines or less. The reports are handwritten, but the penmanship is exquisite and easy to read (could he really be a physician?) He writes “Patient complains of …, my findings are …, my impression is …, and I plan to do the following…”

What else do you need? The patients love him. Why not? He spends his time getting a history and doing a physical-not writing notes with his computer. 

However, I am an internist/cardiologist, and cannot get away with five-line reports. My handwriting is that of a typical physician. So when I look at my note two weeks later, I say to myself, “What was I thinking? I can’t read this writing.”

The purpose of physicians’ notes is as
follows:

 

1. A record for the physician to refer to in order to keep track of history, medication, positive physical findings and diagnosis.

2. A record to be shared with consultants and when there is a change in physicians.

Note: There is nothing in the above list that refers to government regulations, and other silliness. 

The common complaint regarding electronic health records (EHRs) is that their cost is excessive, and the entry of data is time consuming. But there is more. We spent many hours in medical school learning how to take a history. One of the points that was drummed into our skulls is, “Do not just listen to the words. Be alert to non-verbal body language. The patient may say one thing, but indicate something else by his or her body language.” How are you going to see body language when your eyes are glued to the computer?

We have to correct the above problems, but still recognize the computer’s value. The notes are printed and legible. You have a great record of the patient’s current and previous meds. You no longer have to spend a fortune to save old charts. They are all stored electronically. There is one concern; major solar flares occur about once every century. The next one will destroy all our electronic records. 

So how did I fix this? I solved the cost by using free software. Yes, there is free software for your medical records, and you can use your old computers to run it. The program I have is excellent. There is one minor drawback. There is a small block of advertising on one side of the screen. It is not intrusive. Can anybody beat this?

I do not use this program as it is designed. That’s because it is designed to please the government, and since it follows government rules, it has its weaknesses. I enter my patient’s history, and for review of systems I enter only the important negative findings. ”Meaningful Use” is a total waste of our time, and is not good medicine.

Next: I used to enjoy the practice of medicine

 

I resist the temptation to cut and paste. Cut and paste is a joy for the lawyers. In this program there are blocks of space for social history, past medical history, growth progress, family history etc. Entering the data is not really a chore, but remember, we are trying to reduce the “clicks,” and every time you do a new note, each topic requires a click. Think ahead! 

I put past medical history, social history and the rest all in one block, the block that is labeled “past history.” It takes only one click to enter all that data, with the sub-headings, in my note. There is a sub-program for entering “allergy.” You not only have to enter the drug, but the adverse reaction and how serious the reaction was.

This is all very useful, but so time-consuming that it is just not worth entering all that data. I just type into the section on past history the sub-heading of allergy, and put in the text required.

Once you adopt this method of entering data, you make it extremely difficult for our government to mine your charts for information. That’s OK. The purpose of the chart is to serve the patient, and nobody else. I still spend much of my time with my back toward the patient, looking at the screen, but it is not nearly as bad as before when I tried following the rules. The heck with the rules. We know our job, and we don’t need any bureaucrat telling us what to do.

These bureaucrats think that they know more about the practice of medicine than our professors do. Our job is to take care of patients to the best of our ability. Most of my time is spent talking with the patient, less time with the exam, and much less time with the computer.

I am 80 years old, and plan on practicing at least another 15 years. We have all heard of physician burnout, and that there will be a terrible doctor shortage in the next few years. The EHR is only one factor. It seems that the feds are out to make the practice of medicine so onerous that by the time we are 60, we just throw in the towel and walk out the door for the last time.

In addition to the EHR, we have mountains of idiotic codes to contend with. It’s bad enough that each disease has a code, but now we have to be concerned with, is it acute, sub acute or chronic? Is it the third finger of the left hand or the fourth finger of the right hand? There is a code for burns from snow skis catching fire (I swear, this really exists-look it up.)

Then we have to code for the visit. Is it short, super short, long, extremely long or extra extremely long?

I used to enjoy the practice of medicine. I looked forward to seeing my patients, and many of my patients are on a first-name basis. Many patients have expressed surprise at how much time I spend with them. That’s what medicine is about.