Overcoming Obamacare

One of the recent healthcare mandates from the federal government is an electronic medical record (EMR). While many people claim it will vastly improve care, I, the born skeptic, have a few doubts. These doubts have been reinforced by recent visits to my own physicians.

The first thing I started noticing was the computer tablet as they walked into the exam room. All too often now, physicians say hello, sit down and then open the tablet. That is the last I see of their face.

And these are friends of mine!

From the moment the tablet opens all I see of them is the top of their head.

As they inquire about my health they peck away at the tablet instead of looking at me. I don’t like it.

In my 35 years of practicing medicine I think the most useful information I gained about patients was from looking at their nonverbal clues. How they sat, the expressions on their face, the intensity of their emotions, and all the other body language clues gave me much more information than any other source.

In the world of modern medicine, everything depends upon proper documentation, and that means the EMR record. If it is not documented, it was not done. If it is not documented properly, the physician will not get paid. And if it is not documented, the physician is subjected to adverse regulatory actions.

The physician has become a data entry clerk as much as a caregiver.

When I started in emergency medicine 35+ years ago, my documentation was at most a brief paragraph. When I retired last year, the physician part of the chart was more than two pages long. Worse still, most of the two pages were utterly useless information.

What do you, as a patient, do about it?

Beating the System

With the rise of Obamacare and all the other forces driving healthcare, this data entry problem is getting worse, so I suggest the following steps.

First, be assertive.

That does not mean be obnoxious or aggressive. But it does mean claim your territory as a patient. Ask your physician if documentation could be done at the end of the visit or ask that a clerk do the data entry.

Your request will not be popular, but if you want to talk to your physician instead of looking at the top of his or her head, then request an actual face-to-face visit. I consider the physician-patient relationship to be the heart of medical care. A computer should never come between the two sides of that sacred bond.

Second, consider asking for a copy of the record at the end of the visit.

Some practices do this. You will be surprised at the differences in what you think you told your physician and what is recorded. If documentation is that important, then help make it correct.

Does the EMR reflect the visit from your point of view? Were your questions answered? Is the information correct? Is the plan for your care the same as you understand it to be?

Third, for complex visits consider scheduling a longer visit.

In the name of “efficiency,” most visits to primary care physicians are scheduled for 15 minutes. Not much can be explored in that short time. If you come in to see your physician with a list of symptoms it is very doubtful more than the top two can be even partly addressed.

Remember, you are a patient, a human being, not a data generator.

Your health problems rarely fit nicely into a series of check boxes. Maybe I’ll write more about that side of things in a future article.

Editor’s Note: If you’re interested in more from Dr. Rogers, please leave a comment with your thoughts or questions using the link below.

5 Responses to “Overcoming Obamacare”

  1. Steve says:

    I think this is a useless posting. Long before Obamacare visits to a doctors office were exactly the same. Doctors no longer give personal care and time. It’s all about scheduling, or over scheduling, and rushing in and out. Its about volume and money with most medical practices, unfortunately. The tablet has nothing to do with the lack of personal interaction. Before, it was apiece of paper on your chart. No difference.

  2. Frederick Braun says:

    Dr. Rogers you are a kindred soul! I have been an MD for 58 yrs and practiced at least part-time until 6 mos ago. I am Board certified in Pediatrics and Pediatric hematology and oncology practicing each about 1/2 time.The concept that if you didn’t log it you didn’t do it is both stupid and pervasive. Like you my notes were about 5 lines; now 2 pages. If one of my patients goes to the ER, I wind up with about an 8 or 9 page document and with luck, I can find what the ER Doc found that was wrong. The ultimate in absurdity is the statement on a 4 yr old that “patient denies use of alcohol, tobacco, or illegal drugs.” God help us!!

  3. jim says:

    The Doc is spot on. I can count the hairs on my physicians head, but not certain what he looks like since the tablet & he have come together in my appointments.

  4. Ron says:

    Of more concern to me is that doctors today seem to be more statisticianss than experts who make creative and comprehensive diagnoses. The statistics are about the % of patients with a given set of symptoms are helped by this or that drug. The problem is that the diagnosic process is replaced with a match up of the drug with the highest probability of success based on a list of symptoms. That could be done by a clerk.

    As to the tablet. Like most tools it depends on how it is used. My Drs who use one don’t let it replace eye contact. I think it helps by making their note taking faster, easier and more accurate.

  5. M G LaMar says:

    What you have written about is the business/corporate model of medicine. Efficiency and productivity paradigms borrowed from the world of assembly-line manufacturing have been applied to the practice of medicine. The logical fallacy is that human beings are unique and therefore not amenable to mass production thinking.
    I spend 20 to 30 minutes documenting for the few minutes I get to spend with a patient. I am now more a factory worker or data entry clerk than a doctor. It is the reason I plan to retire ASAP.
    I hope to practice medicine again. Perhaps some NGO needs my skills? Imagine that; working where people are just grateful for your skills and service and where no billing codes, insurance games, consumer-driven demands or government regulations interfere with that simple patient-doctor relationship. You know, the reason most of us became a doctor and not a number-cruncher.

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