*Sorry, Ray, but you’re preaching to the choir, here -
1. When I was a medical student, even if they couldn't think of
much else nice to say, preceptors usually complimented the
coherence & legibility of my notes.
2. I work for the Army. 99% of my prescriptions are filled at the
Pharmacy at the hospital at which I work. All of these are entered
electronically into the computer.*
You’re only in the choir because the US Govt. pays you to be, right?
This has +s and -s; while
Seldane and Feldene are hard to confuse in this system, it IS
distressingly easy to put in the right prescription under the wrong
patient.
If both full name and serial number have to match, how is ID-matching in this case more of a problem than with the handwriting of MDs who don’t care how they spell someone’s name or whether a few digits in a number are different?
Since I no longer have any reason to carry a prescription
pad around, I can’t write a prescription on-the-spot for someone I
meet in the hallway; truly a mixed blessing.
Enter the prescription into the system with your Palm Pilot. Let the patient in the hall go to the nearest printout station for hard copy. How often does this scenario come up anyway?
*Doctor's notes, until recently, were viewed simply as reminders to
the docs themselves about what they were thinking, & why they
did certain things the way they did.*
Pfffffff!!! Recent? I’m 68. The above never was true in my lifetime! Nobody cares what MDs write strictly to themselves, i.e., so long as it’s not accessible to anyone else, including other MDs and all employees of their offices and associated facilities, all other providers, HMOs, insurance companies, government authorities (exc. where legally not covered by doctor-patient confidentiality), relatives and the Mafia. I don’t care if they write “Pt. hates MDs” in their strictly personal reminder notes, so long as they know they are subject to huge lawsuits if their security be found to be insufficient to keep such “information” from all others.
Once rising malpractice suits
and insurance company scrutiny created the concept that the
notes MUST reflect everything that was done (if you didn’t
document it, you didn’t do it), and accrediting organizations
started also requiring complete documentation, doctor’s notes
suddenly had to be legible to everyone, not just to themselves.
Let us note here that this MD, and almost all of them, doesn’t care a whit about impediments to the patient’s access to often ignorant, stupid, fantastic or malicious material placed in his/her record by an MD.
*This coincided with an increasingly mobile society and frequent
health care plan/provider changes that made it medically crucial
to be able to "seamlessly" continue care started by someone else.*
You and essentially all MDs clearly feel “seamless[ness]” between providers is a plus to one’s health. Often a change of provider is effected by the patient as a result of knowledge or suspicion that the current provider is quite off the proper track for improving or maintaining his/her health. I have found utter garbage and some considerable hostility recorded in MDs’ records on my consultations with / treatments by them. Almost always, I desire complete severance at the seam. If there be a need to transmit info on past events or treatments relevant to a consultation with a new provider, usually I will want myself to be the conduit of all info on what went on before, and I will want to provide same in such interleaved sequence with physiological examination and original reasoning of the new provider as I believe is in the interest of my health, not in that of the egos and game-playing of MDs.
*Voice recognition technology is not quite there yet. Paying for
100% transcription of doctors notes is expensive; many clinics do
it, but many others cannot. Typed notes will be the rule in the
near future, clearly,*
Instead of MDs’ trying to be overlords and sociologists as well as physicians, let them become typists as well as the latter. I’m not clear on what goes on in the schools today. All these kids using computers from before kindergarten – do they just continue to hunt and peck, or are they ever stuck into typing classes en masse? In the process of typing into a text editor / wordprocessor you end up with much more coherent notes, as a result of the ease of correction made available, as well as notes that are more legible. (That aspect of writing may be more applicable to me than to you.)
but… since these notes are subject to
review by so many people, doctor’s have to separately keep any
notes intended strictly for themselves… suspicions about a
patient who frequently demands narcotics, illegal drug use, or
domestic violence that they might want to bring up in future
visits. Since patients, their lawyers, & their insurance companies
may all have access to these notes, any concerns like these need
to be kept out of notes unless pretty well-substantiated.
Well, they may want to but they shouldn’t necessarily have to in many cases. Whatever; they aren’t done-over, duplicate notes, obviously.
This,
combined with ridiculously short clinic visits, makes it less likely
that the domestic abuse that causes the depression that causes
the headaches that causes the clinic visit ever gets addressed.
Instead, a woman goes home with an imprinted prescription for
Midrin, and gets beaten to death that night…
In most cases, I think the MD, in getting into such things, is taking on a role outside his/her profession. That sort of thing is one of the things I hate most about physicians. They train mostly through rote memory, because they don’t like science and mathematics; they don’t observe normal or dysfunctional physiology well; they don’t reason well from what they do pick up on to some extent, because they hang onto prehistoric paradigms – but they love to jump into things that are beyond their bailiwick. They probably have time at a consultation to ask the patient if she would consider talking to a social worker in some general way. A note only to herself that she had done so, would be sufficient to remind her to check on this further at a subsequent consultation with the patient.
*My experience with computer-entered notes is that they are
easier to read, but communicate less. Follow-up notes for a given
patient with a given condition often degenerate into notes in
which 95% of the information is "pre-entered" and little actual
thought process is reflected.*
Yes, blame the computer for this, of course. Look at the posts to this message board. Some have lots of content and many have next to none. I have, in all the non-VA or older VA patient records on me, exactly the same or more amount, of the boilerplate you complain of in their handwritten instances, as I do in their few recent typed instances. Physicians are slaves to their culture; generally, they don’t wish to be driven by specific facts or modern, effective means of organizing them in ways to optimize treatment, rather than containing them in cultural doubletalk for the purpose of filling tomes in medical libraries that collect dust, while reality connect
