I don't use templates. I hate them. I don't care how much time they save.
They make you look like a moron. Not a doctor.
What makes me say this?
Because yesterday I got a letter from a local family practice doc, who I know recently purchased a computer chart system. A note on an 87 year old lady with advanced dementia, who lives in an Alzheimer's nursing home, featured this line:
"The following preventative issues were discussed with the patient: seatbelt use, driving safety, breast self-exam, testicular self-exam, tobacco avoidance, illicit drug use, safe sex, exercise, nutrition, alcohol moderation, caffeine moderation, routine screening for colon/breast/prostate cancer, and weight control."
Either:
1. He's a moron, and really did all that.
2. He's just letting the computer fill in every default, so he can bill for time, and is still a moron.
3. He's not even bothering to see the patients anymore, and is a lazy moron.
Very short conversation with patient
ReplyDeleteChart-driven Medicare fraud
ReplyDeleteOr maybe he's a really good, caring doc who's made the decision that his time is better used in actually caring for his patients and dealing with their problems, rather than perfecting his ability to jump through a bunch of worthless hoops the government has put in his way?
ReplyDeleteThe testicular self exam is particularly helpful for an 87yo terminally confused woman. Did he confirm understanding with a patient demo?
ReplyDeleteIt's a recent purchase,maybe he hasn't figured out how to use it yet. Or he's just an idiot
ReplyDeleteGarbage in, Garbage out...
ReplyDeletewww.southgeek.blogspot.com
Makes me wonder what is in my chart
ReplyDeleteI think I see the pattern in this chart.
ReplyDeleteI hate these kind of notes. You have to wade through acres of crap to get to the essence of the visit.
ReplyDeleteHey, an 87 year old chain smoking gal might still be driving drunk to the coffee shop for a quadruple espresso before meeting one of her crackhead boyfriends for wild unprotected sex.
ReplyDeleteOr that might just be my grandma.
Personally I think that standardized EMRs are perfect for data mining. For public health, they could really help our understanding of where the doctors' advice/directions correlate with the outcomes. But not if they are no used correctly. And one place I worked had on entry for 'immature cataracts" so the techs would always just check "juvenile cataracts," which is something completely different. It is hard to list EVERYTHING. Like I could put fracture of tibia, but I could not qualify the type, location, nature, etc. Frustrating and it made me feel like a bad doctor. Of course, the other doctor that allowed the unlicensed (ie trained on the job) techs enter his notes had all sorts of mistakes in his written record. Palpation is not the same as palpitate.
ReplyDeleteExplanation : he did indeed discuss all of these with her. Then checked to see how much she had remembered. Valid diagnostic technique for dementia?
ReplyDeleteAnd the insurance (Freudian slip, I typed "unsurance") companies continue to deny life-saving diagnostic procedures and treatment because they can't determine who is legit and who is ripping them off...
ReplyDelete.
Or...maybe the EMR sucks and poor doc doesn't quite know how to navigate the template, got frustrated, and said "fuggedaboudit" (or something else not nearly as nice). I see this kind of thing occasionally in our EMR and if you don't know any better you wind up thinking the doc is a dimwit. (Here's to hoping he's a dimwit and not fraudulent. I'm thinking he wasn't paying attention.) But I know it's a lot of point and click behind the scenes and it looks like he clicked on some wrong stuff, LOL!
ReplyDeleteI tend to try to give people the benefit of the doubt. To me it seems like the program probably had a list where you just clicked off everything you wanted to remove and the doc assumed the opposite. Since the doc logically would not discuss any of that with an advanced dementia patient he probably skipped the question.
ReplyDeleteInsurance companies used to complain that docs didn't REALLY deserve their payment, because they didn't document that they actually did stuff.
ReplyDeleteSo now their EHR documents everything, whether they did it or not. And insurance companies complain that doctors are documenting too much.
My doc won't use EHR, for the same reason you won't.
Ah, templates. Such an interesting juxtaposition to include mention of both the breast and the testicular self-exams. Perhaps it was written with the vast crowds of hermaphrodite patients in mind.
ReplyDeleteOR MAYBE HE LEFT HIS VISION "CHEATERS" IN THE FIRST EXAM ROOM, AND CANT SEE THE LITTLE TYPE
ReplyDeleteNo doubt, what a fraud. This type of stuff makes me sick; Dr. Wastespace does nothing while actual patients that can't defend themselves suffer the consequences.
ReplyDeleteI previously worked in a hospital system in which yesterday's note could be copied into today's note, labs would update automatically and you'd just make the appropriate changes.
ReplyDeleteIt was great except when people didn't make the changes. Some patient's plan might include a surgery the following day, even if the patient had the surgery last week....
You can do this even without electronics. Hospital told us we would 'save time' by not charting normals, just use the flow sheet. So the flow sheet is 8 closely spaced pages. What happened was that the nurse who admitted the patient did it once, then all the answers were copied for the whole rest of the hospital stay. Dangerous legally-I had nurses tell me in report the patient had crackles in the bases, but they checked "no adventitious lung sounds." Worse, they charted the crackles in their written note. If a lawyer ever got a hold of that... Not to mention that these flow sheets made us lie; you just had to check "turned and positioned q 2 hrs" even though you highly doubt the aide really did that. I just stopped doing flow sheets, put my assessment in the written notes. Sometimes they told me I didn't have to write all that, but no one ever said anything about not doing the flow sheets. I don't think anyone ever looked at them.
ReplyDeleteNow I am a disability analyst and I read these medical records you talk about all the time. They say the same things month after month and you have to strain your eyes to find the one thing different between the January and the February note. There is all sorts of meaningless garbage in them which has to be combed through to find an actual medical observation.
Susan Peterson