Overcoming Obamacare

Dr. Otto Rogers, M.D., P.A. By Dr. Otto Rogers, M.D., P.A., Guest Editor, The Oxford Club

Retirement Planning

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.