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Wednesday, April 1. 2015
This is the sort of crap that drives docs to retirement. It's called "electronic medical records," and it is essentially government-mandated in hospitals now. It is an incredible time-waster, and almost requires physicians to follow a script instead of focusing on you. Docs used to just note relevant positives and relevant negatives quickly on a piece of paper in a minute, and then practicing the art and science of caring about you.
"Care" is not an economic term. It is not a technical term. The "medical care" experts don't get that.
Read it and weep: Please Choose One.
It's too late to keep corporate and government bureaucracy out of American medicine. We all must now just seek out physicians with the traditional, independent medical values, who work for you despite the intrusions. However, most of them will not "take insurance" anymore. They can't afford the professionally-trained billing staff.
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I'm guessing that Docs are just protecting themselves by examining, reexamining, and reexamining again their every act and how they report it.
Digital Defensive Medicine. Every keystroke can be used against you. Forever. And so can the absence of keystrokes.
It is crap. I have an old school GP that I love. He does full physicals, where he checks my reflexes. He's taken a minute to pray for me, when I was upset. He never lets himself get rushed. He dictates his notes at the end of the visit and doesn't pay any attention to the computer before then. I don't know what I'll do when he retires.
That's what everybody wants. A medical friend, not a technician.
My doctor looked at my computer records while I had my checkup, updating them along the way. She told me how useful the records were - but how much she hated them. I asked why. She said there is a group of doctors who believe the records hold more answers than they really do. She said I'd notice it if I ever visited one of the other doctors in her practice - telling me which one.
I had him a few months later, when she was unavailable and I was having a problem. She was dead on correct. He was completely overreliant on the data in the system, and asked me virtually no questions....which got me upset because until I explained to him what issues I was facing, he was feeling my symptoms were predetermined by something else in my past.
As it turned out, he was right - but it wasn't what he thought. Determining that took a visit to a specialist.
It's really simple and doctors aren't (all) stupid.
Very few doctors are still paid by their patients. Instead, they are paid by government programs (such as Medicare) or by an insurance companies selected by an employer.
There's a big difference from just 25 years ago. Back then, most doctors who took Medicare or insurance didn't "take assignment". They billed the patient and then sent a copy of the charges to Medicare or the PATIENT'S insurance company which then reimbursed the patient using its own fee schedule. There were two contracts - one between the doctor and the patient and another between the patent and the insurance company (or Medicare).
Today, the contract is between the doctor and Medicare or the EMPLOYER'S insurance company. Note the difference that occurs when the patient selects his own insurance company and when one is mandated for him by his employer - who do you think the insurance company listens to?
Today's doctors understand who is paying the bills and who is just a passive player with little choice. Patients over 65 are captives of Medicare. Patients under 65 are captives of their employer's insurance company. Doctors respond to those who are paying them rater than those who are simply along for the ride.
I had to have some surgery a couple of years ago. Both before and after the operation, every time I met with the surgeon/doctor, he was entering my data into his laptop as he was talking with me.
The same thing now happens with my dermatologist. They are basically filling in their interview reports, not really talking to me.
No computer can use, analyze or understand the reams of data being collected. It requires a trained human, a talented doctor or other professional. But the sheer volume of information is totally beyond the ability of the medical team to comprehend and the time they have available is constantly being reduced by the ever increasing demands of the Federal overlords for their time.
We are heading in the wrong direction.
My own doctor tells me he can see 25% fewer patients due to the burden of computer record input and reporting. He sees no benefit to any of it.
This week two of my relatives have had their family members undergo serious surgery with way too many after effects requiring rehospitalization and extra-ordinary medical care. Both are within the same "system" although at different hospitals. Both situations could have been avoided if the docs in charge had insisted on more in-depth discussion with the potential caretakers and one or two more days under the supervision of expert medical staff and monitoring. All the time spent punching in data to their computers did nothing that common sense couldn't have predicted.
I typically would not advise anyone stay in a hospital any longer than necessary -- they are germ breeders and opportunities for mistakes of every nature -- but when dealing with a patient who has multiple disfunctions (diabetes and by-pass), stabilizing that patient requires more than a rehab facility or home care can provide. Nothing replaces a good chat with the patient and his/her caregivers. Old but true about computers: garbage in, garbage out.
It seems to me that the complaints here presented indicate that doctors are using and/or being made to used computers in inappropriate ways. There should be no reason that doctors could not use computers only to replace the paper on which they have long taken their notes. Those notes would then enjoy the benefits of machine readable data (the abilities to search, sort, transmit,etc.) that paper lacks. When those data are combined with other aspects that should be already recorded as machine readable data by nurses and physician assistants (hospital and medication history and the like) a powerful information set could be readily available to facilitate current and future care.
Agreed. I install EMR software in Canada and there are many benefits. Legible prescriptions, No more paper charts to lose, All information is in a single place for any physician to view, Easy graphing of important measurements, etc.
According to my clients, the EMR does not save them time, it just makes them better doctors.
They choose how they use the EMR, not the other way around.
The cost savings are also there in less space to store files, quicker reporting, etc.
Just because the US government is forcing EMRs on physicians doesn't mean they are universally bad...
Contrary to what seems to be a common misunderstanding, the government's reason for forcing doctors to use EMRs has nothing to do with better or more efficient medical care - at least as the patient and doctor interpret "better". Rather, it's so that the government can monitor, and hence control, what doctors are doing (and what patients are receiving).
The government knew that they couldn't sell this system of "oversight" - which is evolving into a system where federal officials tell doctors what they can and cannot do and patients what they can and cannot have - for what it really is. So, they did what they usually do - they created the perception in voters that they were crafting these rules to lower costs and improve quality.
Now, to be fair, this didn't start with Obama. The purpose of HIPAA, signed into law by Bill Clinton, wasn't really to ensure patient's privacy. It was meant to create the illusion of privacy while granting the government greater access to your medical records and making it easier for the government to collect information about which doctors were "outliers", i.e. those doctors who provided - in the government's opinion - "too much" care.
Electronic medical records may have a place in helping doctors provide better care, but not when they are forced on doctors and certainly not when the data that MUST be entered is determined by the wants of the government so that it can monitor and control rather than the wants and needs of the doctor so that he can provide better care. If EMRs truly improved outcomes and lowered costs in a trade-off that was desired by consumers (doctors and patients), there would be no need for government to enforce their use.
You are perfectly correct. EMRs are no more about patient care than the VA is about Veteran care or the DOJ is about justice. EMRs are about controlling doctors.
EMRs dumb down records and suppress clinical reasoning. They are destroying medicine. It is a crime.
Sadly many doctors are using them now instead of interaction with the patient in order to reach conclusions about the patient.
They can indeed be a great help. I've gone through many doctors in the same practice over the last several years, as both me and my regular GP had chronic health issues so he was rarely available when I needed to see a doctor, leading me to be treated by 5 different ones in the same practice over the course of less than 2 years (before one finally decided it was time to send me on to a specialist).
Without computerised records, they'd not have had access to my medical past. Sadly a lot of them see those computerised records as a substitute for actually talking to, let alone examining, the patient.
More than one never laid eyes on me during the entire consult, just gruntingly asked a few questions with the answers being typed into the computer, never taking their eyes off the screen.
It does indeed help with printed prescriptions, leaving less room for error at the pharmacy, but one has to wonder why those prescriptions still need to be printed at all, what with the pharmacy being linked into the same EMR system and having full access to your medical data which they use (or are supposed to use) to double check whether the medication you get prescribed doesn't clash with other stuff you're getting.
The article was posted as 'Fiction".
It is wrong to draw conclusions from these kinds of articles.
I would be happy to put you in touch with many doctors who are happy with their EMR. http://oscarcanada.org/
I don't know many doctors who are "happy" with EMR. It could have been a real aid but it has been badly designed and written. Some years ago, I saw a nice surgeon's office management program written by a young surgeon using Visual Basic. I learned to program in Assembly Language many years ago. I was an enthusiast until the latest versions came along.