Viewpoints: Talk Back

August 6, 2010

Letters address midlevel usage, malpractice reform and electronic health records.

Refreshing perspective

I thoroughly enjoyed reading the Practicing Excellence profile that Senior Editor Morgan Lewis wrote about Dr. Nevada Lee in Missouri ("All Medicare, [almost] all the time...and loving it," July 23 issue).

It is refreshing to see a medical professional care more about her patients than a paycheck.

NIKKI ROSS INDA
Tampa, Florida

Give EHRs a chance

I would like to wish Dr. Brian Meeker luck on his search for an electronic health record (EHR) ("Another perspective on electronic health records: Is typing during a patient exam akin to texting while driving?" May 7 issue). As a physician who takes the laptop into the exam room, perhaps you should try it before you knock it.

I type the HPI instead of writing handwritten notes and then dictating. By typing part of the visit, I am able to complete my medical records in a timely manner. I also access the same things on the computer that Dr. Meeker accesses on his phone, since we have no cellular coverage in our clinic.

The academic practice where I work has saved significantly by having physicians type, but voice recognition software is an alternative available to all doctors. We have saved significantly on transcription and have almost eliminated it entirely.

We continue to have a larger medical records department than we anticipated, but they perform different duties. They spend their days labeling and scanning in tests and consultations rather than pulling and filing the old paper charts. We now never have to see a patient without a chart because it is lost. Residents are often asked to see patients whom they have never met, and they always have the patients' information at their fingertips.

That is my favorite feature of EHRs so far.

AMY J. KEENUM, PHARMD, DO
Knoxville, Tennessee

EHRs overrated

After reading Dr. Meeker's article, I applaud his observations thunderously. I have been in family practice since 1968 and have witnessed the usual revolutionary advances that have been touted and have been unimpressed with the improvement in medical care related to technology (with a very few exceptions). Medical care is, first and foremost, how well a physician extracts a pertinent medical history and performs his or her physical examination. Almost all necessary information, at least for the immediate time, can be gleaned from such a session.

The EHR is vastly over-rated and is, at best, technology for the sake of technology; it is costly, it is complicated, and it is, for the most part, unnecessary in providing quality, humanitarian medical care. The quality of the information in the EHR is directly proportional to the quality (and honesty) of the information entered.

I'm sure that EHRs have a place on the medical scene, but it's a limited one at best. EHRs certainly do not belong in a neighborhood family practice.

ALLAN AVEN, MD
Arlington Heights, Illinois

Much ado about earwax

I enjoyed Dr. Meeker's column about EHRs. I recently received an EHR consult from an ENT physician that was five pages long.

The punch line was he removed some impacted cerumen.

STEPHEN HELPER, MD
Bakersfield, California

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