Thursday, December 30, 2010

ONE THOUSAND CHARACTERS


The NY Times’ “Well Blog” often presents juicy morsels of medical issues, and today’s (http://well.blogs.nytimes.com/2010/12/30/the-doctor-vs-the-computer/?pagemode=print) is worth reading.

Internist Dr. Danielle Ofri writes about a difficulty she’s encountered with electronic medical records (EMR). Certainly EMR is an improvement over paper records, as it’s universally accessible and pages don’t tear, crumble and get lost. But the folks who control its use, like so much within healthcare administration today, aren’t medical people. With little idea of what occurs between patients and doctors, their main concerns are with their own technologies. So one parameter they place on EMRs is word count: docs can write only so much in a medical record entry.

Dr. Ofri reports, “…in our electronic medical record system there is a 1,000-character maximum in the ‘assessment’ field.” She felt she needed to write more about one patient, so in desperation she phoned the help desk. A techie told her, “Well, we can’t have the doctors rambling on forever.”

Dr. Ofri good-humoredly concludes, “For my next medical evaluation, I think I will use haiku.”

I once knew a medical resident who understood his patients’ situations so thoroughly that his writeups rarely exceeded two elegant sentences. I worship such graceful brevity. But he’s a rare doc, and in any case the issue here isn’t about doctors rambling on forever. It’s about still another entity coming between patient and doctor.

As if insurance carriers, government agencies, and the consequences of reduced reimbursements didn’t crowd the examining room enough, now information technologies are limiting the transmission of all-important information.

We have a boiling frog here. You know the story. Put a frog in a pot of water, and if you heat it slowly enough the frog won’t notice until it’s boiled to a turn. In the same way, the patient-doctor relationship has been eroded almost imperceptibly over decades. The parties feel increasingly uncomfortable and angry, but aren’t clear about why. One wonders when they’ll finally tell the interlopers, “No. I'll write all the characters I need, and as for you characters: out.”   




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