From the
President
BRUCE A. SCOTT, MD
GLMS President | [email protected]
FOCUS ON THE PATIENT NOT THE COMPUTER
A
few years ago, a long-practicing general surgeon told me he had decided
to retire. I inquired as to the motivation behind his decision, that although reasonable given his chronological age seemed
premature given his continued vitality, mental
capacity and surgical skills. He told me that
he had examined thousands of patients with
inguinal hernias over his years in practice, and
that by reviewing his notes he would clearly
have an image of a given patient and their condition. When a patient returned years later or
if he was ever asked in a court of law he could
confidently recall the details of his care. He
went on to tell me that his practice, acquired
by a hospital system, had implemented an
Electronic Health Record (EHR) system, and
that now he had four choices to select from
to describe an inguinal hernia. Finding this
unacceptable he typed detailed descriptions
rather than succumb to the temptation of
the template, but his productivity suffered
and he wasn’t meeting the “quota.” Rather
than compromise the care he provided and
potentially the reputation he had built over
the years, he elected to retire.
A recent study by the RAND Corporation,
sponsored by the American Medical Association, reviewed factors affecting physician
satisfaction. The author, Mark Friedberg,
MD, noted, “Physicians described feeling
stressed and unhappy when they see barriers preventing them from providing quality
care.” In the study, physicians complained that
EHRs require physicians to spend too much
time doing clerical work, time that could be
better spent caring for patients. There is no
question that data entry is an inefficient use of
physician time and yet this is exactly what we
are increasingly forced to do. The study found
EHR systems were a major driver of physician
frustration and dissatisfaction.
Beyond inefficiency and physician unhappiness the study had even more concerning
findings. We know that high quality physician
documentation is critical to patient care, and
it was thought that electronic documentation
would result in more thorough clinical documentation. Contrary to this goal, the RAND
study found that physicians were convinced
there was degradation of meaningful clinical
documentation because of EHR. How often
have you seen multiple pages of electronic
cut and paste garbage that adds nothing to
patient care? Physicians are trained as independent thinkers who believe every patient
is unique, but templates and “drop down box
choices” can make every patient look alike.
Potentially even worse, the prepopulated
template is automated to the point that I fear
we are sometimes not aware of the misinformation that is perpetuated. In addition,
it was thought that electronic records would
facilitate research to improve care protocols
and outcomes. Sure it will be easier to search
the record database, but how meaningful are
the result ́