With new changes, health care industry is focused on the wrong things
I’m a stomach doc. I’ve seen thousands of patients, inside and out, for 25 years. I’ve done research, I’ve taught, I’ve been an administrator. And as the years rolled by, I’ve watched the health care industry begin to undo health care itself. It’s complex, cumbersome and bureaucratic, and the bigger the practice or the clinic or the hospital and research facilities — like the universities I used to work at — the worse the problem.
For a physician and his patient, the exam room visit is everything. Healing begins right then and there. The process of telling your story, being heard, being touched and feeling connected to your doctor is an incredibly powerful element of healing.
While we’re bombarded with the latest and greatest discoveries and inventions of medical science, the fact of the matter is that most people who walk into a doctor’s office don’t have some horrible disease. They simply don’t feel well. My job is to listen and observe, to figure out who really does have something bad going on and who may simply be feeling the effects of life’s wear and tear.
There’s a huge difference between that and the health care industry, which is more about industry than health or care. Third-party payors don’t really care what happens in an exam room. The visit that you, as a patient, have been anxiously waiting for could just as easily be shoes or oranges or pork bellies to these folks. It’s just a commodity. It’s just data. And now the industry wants it documented in a format that works for billers and statisticians but not so much for doctors: the electronic medical record.
That’s the note your doctor is probably busy pecking away at while you’re trying to explain what ails you. In theory, an EMR should make care better and more efficient. It’s falling pretty far short of that goal.
For starters, a lot of the software is clunky and the way it asks for information is unnatural. It can take more time to complete the “necessary” documentation for a colonoscopy or other endoscopic procedure than it took to do the procedure itself. Doctors and nurses and lab techs suddenly have to be data-entry clerks, filling in multiple “fields” and negotiating drop-down menus.
I’ve seen nurses get so busy typing what they do, they can’t do it. I’ve watched when an alarm sounded, indicating that a patient was breathing inadequately — the sensor had simply fallen off the patient’s finger. The nurse, back to the patient and typing furiously, shouts “Breathe!” without ever looking around. These aren’t bad nurses; they’re good nurses in bad situations.
I had my first encounter with an electronic medical record as a patient at my internist’s office. I consider him to be a model physician: smart, conversational, part friend and part counselor. I was pretty stunned, then, when I mostly saw the back of his head as he asked me questions and typed, badly.
“Hey, Jeff, does any of this look like a good doctor-patient interaction?” I asked. “H—, no,” was the prompt reply. “But I’ve got to do this now or I’ll never get finished on time.”
Whatever the EMR may become, right now it’s mostly a receipt for a transaction, a bill of sale. We all want to be sure we’re getting what we pay for. The government and insurance companies are no different — they require lots of documentation. What gets entered into the “elements of the encounter” field on the EMR determines how much the insurance company will pay, which only makes the unholy mess of electronic medical records worse.
With doctors everywhere working more for less, the pressure is on to perform lots of “elements” and to treat these notes like an old Chinese restaurant menu: “One from column A, two from column B .”
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