Lemme take a minute to tell anyone out there that thinks electronic medical records will improve life for doctors a little story.
There was once medicine. It was practiced where the doctor looked at the patient when they were talking, maybe took a few notes. The patient and doctor did their best to figure out what was best for the patient and sometimes lab results went missing, and charts took time to file, but that was part of life.
Now, the computer screen is being watched, the "provider" is not seeing the patient because they're looking for the 6pt clicky box to check for each symptom the patient is mentionings, and in going between screens missing about 10 symptoms- both in documenting and in hearing.
The computer crashes and there is nothing you can do aside from scribble notes on a piece of paper. You can't write prescriptions because no one has prescription paper pads anymore and the controlled medication prescription papers need to be filled out by computer. And if you need to go over labs or results... for get it.
And then.. the best part... you get rated on "quality of care" no longer do you get to discuss the options with your patient and decide what's best for them- nope. You get graded on percentage of your patients that have government clicky-boxes checked. When you hear the president talk about "we're going to pay the most efficient doctors" or that sort of wording, just remember they're treating you like a multiple choice clicky box and if you refuse the flu shot your doctor will be graded as incompetent.
As you might guess, there's a bit of a bee in my bonnet this week. I got my "random audit" of my August visits. And would you believe I failed 100% at giving my patient the flu vaccine in August. uh, HELLO? govt audit agency? We don't HAVE the vaccine to give in August. And today, of 15 patients, I had 3 say "yes, I'd love to pay an extra $20 and get the flu vaccine" the rest said "are you kidding me? it's 100 degrees out, I can't think of the flu right now and I never get the vaccine and I never get sick" so my audit this month will be crap, too.
Not to mention that 11% of the patients I saw had a Hgb A1c of >9%. uh... for 1, I'm seeing the person for the first time, so it's not like anything I did had any effect on the previous 3 months and their current A1c. For 2, dear govt agency, do you realize that a vast majority of our patients show up with meds from other countries and cross the border all the time for their care?
For example, I saw an immigrant who brought in her metformin and glyburide and tells me she's taking 1000mg of metformin bid and 20 mg of the glyburide bid. yep. When was the last time her sugar was checked? 1997? We've seen her for 4 years and never before had she mentioned she had diabetes, but her overseas source of her med dried up and suddenly she's got a random glucose of 300+ and would like her meds refilled. Oh, yeah, and she doesn't feel good.
Don't cha think mentioning to your doctor that you have diabetes might be a good idea?
Similarly, a woman presents for a mammogram. Ask, are you having any problems. "well, yes, I'm having pain" (this is of course in spanish) ok, well, let's take a look and WHOA nelly.. uh, this is a surgical site. did you have surgery here? Yes, 2 days ago.
For one... dear MA's rooming patients, I know you're pressed for time and don't have time to find the right clicky boxes in the medical records for this, but alittle heads up of "she had surgery 2 days ago" helps. ESPECIALLY if she's there for you to re-dress it and thinks you're taking her sutures out. A little help with my spanish to explain you don't take sutures out of anything 2 days after major surgery. And if you think this is rare... it isn't. This is in fact the second time in 6 months that this has happened. Apparently you go to mexico to have the lump removed, the doctor there says you need a mammogram, but in mexico you pay for your mammograms. If you come to CA, the state pays for it.
No one should wonder why we're bankrupt as a state here. no one.
BUT back to our dear government standards... so they're going to require medical persons to do testing and treat beyond side effects and patient desires to get numbers where they are, they're going to require us to put everyone on certain meds because that's what certain studies say is best, regardless if the patient wants it or not, and then they're going to make sure the government taxes us to pay for it. I mean I understand there's some logic there, but not really. Can't some of us make decisions for ourselves?
If any of my kids tell me they want to go into medicine, I'm going to steer them to plumbing- the hours might be worse but the autonomy and pay is better.
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