Saturday, May 24, 2014

Does the Electronic Medical Record Destroy the Process of Seeing a Physician ?

      





  Lately, a number of friends of mine have said that they "will not be returning to see a physician" and that they "will simply die when they run out of things they can do for themselves". They cite that it is not worth the two or three hundred dollars, not to receive any wisdom or any solutions as "all the doctor did was spend time filling out a check sheet on a computer."    It is disturbing to hear this from many sources at once who use a variety of health systems in several different areas.  It means that both our medical system in the US, and also that the pressures that Obamacare has brought to the fore have destroyed the process of seeing your physician as it was intended. The new system disables using physicians as they were, in fact, trained.

             When you see a physician, you actually aren't paying for a prescription for a particular drug, and many times, not for an actual procedure of some kind.  You are paying for someone who should be fairly bright and engaged in health promotion who has spent four years of college, four years of medical school, one year of internship and then three, four or five of residency in some specialty to look at you, listen to your concerns and make as assessment of your health with recommendations. Many physicians have also completed a fellowship in a sub-specialty, which can also be an additional couple of years.  A good physician, (as well as a good nurse with experience) should be able to pleasantly interact with someone and provided you have their full attention, should be able to notice everything from your demeanor, the manner in which someone is speaking to them, the absence or character  of your movements, a pained look, a waxy complexion, an enlarged thyroid, alterations in normal respirations,  etc.   In fact, the process of continual patient assessment using a glance, is not something that can be turned off very easily once it is well established.  Only an attorney who is not a physician (there are people who have become both)  would have generated an electronic check sheet for documentation which takes the physician's eyes off the patient, and onto a computer screen.  This means that you are no longer getting the full benefit of a physician's impression of your general health for your money.  It means that the focus of your medical visit is no longer the patient, but the simple documentation of an electronic record.  The Obamacare System is less interested, it appears, on the assessment of the patient, diagnosis of a problem and on providing good comprehensive care, but on the documentation of all that is known about your health.

            It didn't take much time for me to look through the literature to see that physicians are also complaining about the effects of the Obamacare imposed seeming singular devotion to the electronic medical record.  Some of them have found themselves leaving private data off the patient's record because there is inadequate room to explain. Others have expressed that the software is limited and does not have the flexibility to insert data and diagnoses which are actually known.

           One of the members of my own family sees a major world class medical center here in Virginia.   He sees the physician for longstanding follow up of Crohn's disease.  Keeping weight on has been a challenge since this diagnosis was  made.  In the past, on one of his ER visits, a nurse or a physician confused which patient's data was on that pod's emergency room screen and someone confused as to on whose medical record they were actually working.  Somehow, my underweight family member wound up with an  erroneous   supplemental diagnosis of morbid obesity !  Of course, this was so ridiculous that at the next visit with the primary care physician, they asked about it.  I said that this was clearly an error from the ER visit and I asked that it be removed.  We were told that incorrect data on the medical record can never be removed.  They simply amended the entry with "problem solved."  It still exists in health history !    Even though I said that the entire erroneous entry should be removed because there may be future implications, they told me this was impossible.   What happens when gonorrhea, morbid obesity, HIV-AIDS, lupus, Lyme Disease, Huntington's Chorea, or schizophrenia make their way erroneously to your medical record ?  What happens if someone enters the labwork of a diabetic on your medical record, and not your own ?  I'm betting the results could be interesting, if not devastating.  The effects may be that on subsequent hospitalizations for the rest of your life, you will have a fasting blood sugar drawn that you might really need and don't wish to pay for,  and you will be placed on a diabetic diet automatically on hospital admission for anything.  The problem with computers is that they make very fast, very accurate mistakes and that corrections are not easily made afterward, if ever.

           A few physicians have started to pay out of their own pockets for a scribe who will write the electronic medical record while the physician keeps his assessment eyes on you.  Of course, this might work well for some physicians and some types of practices, but it also leaves the creation and potential errors in the record to a non-physician.  It also adds another person in the room and could impede the freedom by which the patient discusses things with the physician.

          I do understand that there is value in a computerized  and hopefully neater record of the patient encounter which, at the very least, should be legible, and from that standpoint alone should result in better care.  Patient directions may also be more easily printed and provided to the patient.   However, the devotion to collecting all of our health data in a centralized location which can be accessed by government as well strikes me as simply frightening.  There may be some darker implications for patients too. As a registered nurse, it worries me that some patients, for example, women who may have post-partum depression or even post-partum psychosis might not feel safe enough now to share such a concern with their physician, as soon as they might have before. How private can the data in your medical record ever really be when government has access to it ?

          How long will it be before a criminal underground exists which provides medical care without an electronic record ?  Well at least someone will have a job.




UPDATE:    June 20, 2014

It appears I am not the only person worried about this and noting these challenges.   See this link dated today,  from a physician's blog:

  http://www.kevinmd.com/blog/2014/06/scribes-become-pervasive-health-care.html?utm_content=buffer8400d&utm_medium=social&utm_source=linkedin.com&utm_campaign=buffer

18 comments:

Mamma Bear said...

Papa Bear went to his dermatologist for a follow up from a skin cancer that was removed from his back. He said they even took his photo that must now go into the records. 30 minutes or more was spent with someone typing into a computer while he was in the room. Not much was done for his problem of scar tissue that was burning and itching at the surgical site. They finally gave him an injection and told him to return in two weeks but they could only give him one more injection in the site. I found ScarAway at the base one used to have to have a prescription for. I put a sheet of this on him for a few days and problem was solved. He canceled his appointment.

This was just minor stuff. I wonder what it's like for something major? I did not sign up for Obama Care nor will I unless I am threatened with jail. I am basically healthy except I have high blood pressure and still have a few months of my prescription medicine left. A new little clinic has opened up in this rural area that I plan to go to. If only a cash basis is not acceptable to them I don't know yet what I am going to do. None of the home remedies work to lower my pressure.

Mamma Bear said...

I meant to add too...Papa Bear heard a discussion on the new rules for Obama Care that if you were being treated for any ailment and the physician declared you cured, you can never be treated for that same thing again. I forgot where he heard this. I hope he misunderstood this as I think about our son who has reoccurring bouts with pneumonia and skin issues from time to time.

Tewshooz said...

Years ago, before computers, I asked for a copy of my medical records. Imagine my horror when I read that I had had a lung removed due to cancer. Absolutely not true. I was told that nothing in a medical record could be erased or removed and that they could only make a note of the error. And that was paper records! Now, since Obamacare, I am not going to volunteer any information to my doctor. It galls me that my medical records are going to be on a govt database somewhere. So much for privacy.

JaneofVirginia said...

Yes, my daughter had digital pictures added to her medical record this week. We used to have to describe lesions Apparently, documentation is more important than treatment.

JaneofVirginia said...

I am not sure what ailments such a rule applies to. Since pneumonia is often a recurrent issue, but may be caused by viruses, bacteria, chemical pneumonia etc. and one could have a different type of pneumonia a number of times, I would imagine one could be treated for a variety of types. What might be true is that at some point Obamacare might cease to pay for recurrences of the same cancer, for example.

JaneofVirginia said...

Yes, an error in a written medical record can only be altered insofar as it can be boxed and a supplemental note written. "This paragraph has been written on the wrong patient. Patient denies hospitalization or treatment for this. No scar is apparent." Then, the amended note should be signed and the title of the RN or MD affixed with the date and time. If that chart ever goes to court, an attorney will have a field day saying that documentation was probably shoddy on the rest of the chart, even though it might not be.
At least you weren't charged for something for someone else ! Years ago, at a hospital I worked in, a person with the same last name as mine who worked at the hospital brought her young daughter into the ER. They asked her daughter's name, but did not check the woman's license. A week later I got a bill for an ER visit my own daughter did not make. I demanded to review my daughter's medical record also. It turned out only to be a billing problem. This is why hospitals now check licenses before treating people.

Tewshooz said...

Today we got a letter from our state's health department asking my husband to participate in a melanoma study because "sometime after 1995 he had a diagnoses of melanoma or related condition that was reported to the Public Health Cancer Registry". Really? He had a mole removed that was benign. No cancer...no privacy either. Nobody ever told him. So, what else has been reported to what agency? We have had the same doctor since then and he is going to get an earful. My one doctor was so busy checking and typing on his little computer that he never looked at me. Then he left the room. His nurse came in with a script and then goodbye, y'all. We live in a small rural town...can't imagine what it's like in a big city.

JaneofVirginia said...

"Tumor Registries" have existed for many years. Public Health departments keep records of clusters of different types of tumors so that records can be kept and conclusions regarding the incidence of certain types of tumors, and for increases and decreases of such growths. If a lipoma, dernatofibroma, polyps, or other benign growths are now being reported, and not just melanomas, and basal cell carcinomas etc. then an awful lot of people are going to appear on such a database, and they may well appear multiple times.

Navy91 said...

Add me to the growing number of disillusioned! I'm being asked questions now that have nothing to do with my health. The information from all of my medical records is now going into a national database that the government has access to?! I'm sorry, I misspoke, I'm actually furious! The government has absolutely NO RIGHT or NEED to see my medical history!!! I'm now working my butt off trying to get some things under control, so I may be able to come off of some medications and cease the quarterly visits. Lying to doctors, I'm sad to say, is going to become a common occurrence. Whatever happened to Dr. - patient privilege?!

Tewshooz said...

So a person is on a data base for cancer when there is no cancer. What does that do for life insurance rates. Insurance companies look at these things? What troubles me is that we have no idea what data bases we are on.

JaneofVirginia said...

My understanding was that cancers are entered into tumor registries. I did not think fibromas, lipomas etc. were placed on such a database. No, we don't know what databases we are on.

JaneofVirginia said...

Yes,

"Do you feel safe in your home ?" "Do you or anyone at your home own a firearm ?"

These are just two of those intrusive "health care" questions.

A lot of people have made a lot of progress this year in regaining their health, losing weight, and coming off medications.
Yes, sadly I agree with you. A lot of people have changed physicians and are starting fresh with someone they will not confide in. A lot of data in the older written records will not actually be transcribed to the new electronic records.

Now, the government thinks they share in "doctor patient privilege.".

BBC said...

I see two problems with Medicaid.

A: People just don't want to die and it is expensive to keep them alive.
B: Too much of the money we pay into it gets wasted, by greed or politicians.

I don't know much much about medicare, I'm too old to bother with that, but everyone I talk to says it is damn expensive.

BBC said...

"Do you feel safe in your home ?" "Do you or anyone at your home own a firearm ?"

Yes, for the most part, at least I can shoot back. That may improve my chances of living one more day. LOL

JaneofVirginia said...

Yes, there is misuse of funds. It doesn't cost much to keep many of us alive. Drugs like lanoxin slow and strengthen the heartrate and have been recognized to extend the healthy lifespan of many people. Low dose aspirin has prevented strokes in many, and although it has inherent hazards when prescribed for the wrong patient, it too, has kept many people alive. Of course, there are some who do cost a fair bit to keep alive as they have complex problems. However, not all of them choose to stay alive because their quality of life is not what they remember.

JaneofVirginia said...

Yes, I am safe in my home. Anyone with a firearm ? For what ? No, why ? We sold our steak knives since the price of steak went through the roof ! Now we eat oatmeal with plastic spoons Do we sound safe enough for you ? No need to send the mayonnaise police here. LOL

Sunita Chaudhar said...

Nice Post.personal health records tracking plan that organizes all types of health & medical records like personal health statistics, regular doctor's visit, allergies, social habits, vaccination and immunization and lot more.Thanks for sharing.
electronic medical records

JaneofVirginia said...

I did a post on creating a family medical record some time ago, which can be accessed at:
http://rationalpreparedness.blogspot.com/2012/03/document-evacuation-bag.html

http://rationalpreparedness.blogspot.com/2014/03/what-you-might-do-next.html

Most families can structure their own records without buying one. Buying a record could make the process faster especially if the history is complex or the family members are numerous.