Marilyn J. Heine MD, oncologist and PMS president, quotes Paul Consolato MD, writing on KevinMD that “[a]doption of EHRs is a transformational event for physicians”. She goes on to say,
Can it be that information technology is now an integral part of any exam?
which leads her to:
I wonder if adoption of EHRs is the largest transformational event for physicians because it’s a generational role reversal within the ranks. We may be at a time in the history of medicine in which freshly minted medical school graduates can teach our older, experienced physicians a thing or two.
“Our younger, computer savvy doctors took to this like a swan to water,” she was quoted in the January 2012 edition. “It wasn’t as easy for some of our other physicians.” The phrase “other physicians” is actually code for older physicians. Imagine this … new physicians becoming mentors to those with decades more experience in patient care.
No, no, no!!
The polite response to all this is “poppycock”; my actual response being more along the lines of male bovine fecal material.
A patient is not his medical record, paper or electronic. The fact that we have morphed into a system where payment is tied to the medical record does not change this. Emphasis has shifted from the provision of medical care to the recording of documentation. There is far too much “technology” without sufficient attention to the “information” in Health IT (which by the way should be MEDICAL IT; subject of another post.)
The real transformational event on this pathway was when someone decided it would be a good idea to create a written record of medical care. I’m sure there were plenty of old Dinosaur Docs back then who grumbled, “I know what I did, the patient knows what I did, and that’s all that matters. Why should I write anything down?” Nevertheless, the value of “casebooks” was quickly appreciated as a memory supplement for the doctor, if nothing else. In fact, that’s the main role my charts play in my day-to-day practice. Who is overwhelmingly likely to ever see what’s written on the thousands of pages jammed onto shelves, and now 15 months of computer files, that contain the written record of my twenty years of medical practice? Me. Other doctors to whom patients may transfer; maybe a few dozen lawyers. Still just a tiny percentage of the information generated will ever be useful or needed in the future. The only change is that I now record the same information by typing on a keyboard instead of scratching with pen and paper.
Information technology is NOT (and never will be) “an integral part of any exam”. Physicians are perfectly capable of eliciting a history, performing a physical examination, generating a differential diagnosis, and treating a patient without writing anything down. The legal dictum, “If it’s not documented, it wasn’t done” is a fiction perpetuated for the explicit purpose of extracting financial gain from medical misfortune, and has nothing to do with reality.
So no, I will not accept as a “mentor” some twenty-something kid with no medical expertise and precious little life experience to speak of merely because of his alleged technological prowess. Learning to elicit the history with skill and compassion, performing the physical examination with expertise and sensitivity, synthesizing the information with the experience of decades of practice, initiating effective and appropriate treatment while educating the patient about the illness, treatment, side effects, course, prognosis, etc: that is the practice of medicine. All the rest is just scribbling; whether with ink or electrons makes no difference.
There is nothing “transformative” about EMRs because medical care is not the same thing as the medical record. Until everyone — policy wonks, doctors, and patients alike — comes to realize this fundamental truth, we aren’t getting anywhere.