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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: