Why Doctors Hate their Computers – New Yorker

Atul Gawande is one of the best writers today, writing on the subject of healthcare, end of life issues and modern medicine in general. You likely have heard him on NPR. Finally, he tackles the aggravation and lost promise of  electronic medical record systems (EMR).

EMRs have been viewed as a panacea by the medical community, primarily by politicians and government administrators lured by the promises of centralized control of medicine with rising costs of patient care, along with lawyers who are seeking to minimize risk of lawsuits. Add to that  hospital administrators, many of whom have never had to fill in a screen of medical data in their lives.

From the medical practitioners I’ve talked to about EMRs they are frustrated with the level of work they have had to do to keep up and the difficulty of finding useful information in the systems. Some patients have lost their lives due to EMRs, as specialized practitioners enter data that is not easily found, and when a patient is admitted to an ER room, often these instructions are lost to the ER techs. Or, to be more precise, they can’t take the time to find them in the mountains of screens. Yes, because of EMRs patients that otherwise may have lived are dead. Gawande alludes to this issue in his article.

Once, physicians could dictate and have the dictation sent to India overnight for translation. They’d have it the next morning. Or they wrote notes that were good enough and ended up in charts where they could be found quickly.

We are now in the worse of all worlds. EMRs are not automated enough to actually save practitioners time. Because of the use of EMRs, the expectations that medical providers can do the work faster and better mean that funding agencies drive providers to work faster and see more patients. A PA I know would spend two hours after seeing over 25 patients a day, before finishing the work of  filling out her EMR records. She was not reimbursed for this effort and she said it affected her home life as well. It’s a story I’m hearing from many practitioners.  At some point in the future dictation will be perfected and finding data that’s critical to patient care in an emergency will be easy to do. Until then, providers will continue to burn out and leave the system, just at a time when we need them more than ever.

We encounter, in Gawande’s article, an administrator who claims that the EMRs are not for the doctors but for the patients. While it’s true that patients use these systems a lot, (myself included) the results that most of us get are simply lab results and some easy to understand notes from our providers. That someone would think that the patient is the focus of all of this is misguided and shows a lack of understanding of systems.  The patient could just have easily have been given this information without the vast back end systems that affect every moment of provider time.  Think I’m wrong? It’s the backbone of every app you run on your smart phones. They are small and customer/consumer focused. We create these systems all the time. Requirements? Just listen to the customer. No need for thousands of hours of input meetings and lawyers.

It’s time to demand better EMR systems, focused on the needs of the providers and patients, not the hospital administrators, the lawyers, government and private insurers and the like. It can be done.

With all that said, Gawande’s article is the best thing I’ve read yet that gives a clear lay of the land of the frustration that physicians are feeling about EMRs. Take a read.

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers/amp

 

 

 

One-of-a kind collaboration expected to train health care workers on Peninsula – PDN

This is a great idea to try and work to train and bring on qualified local people quickly.  Thanks to the Littlejohns and the Jamestown S’Klallam Tribe for also helping to fund the initiative. Jefferson Healthcare has tried with little success to find medical professionals willing to relocate here for the long term. I personally have seen them pass over qualified local candidates in favor of people from elsewhere, only to see them leave after a few years of work here. Now this program presents the opportunity to grow candidates on the peninsula, which is far more likely to having them stay for the long haul. A good use of our tax dollars, I’d say.

PORT ANGELES — Peninsula College is teaming up with health care providers from Clallam and Jefferson counties in a wide-ranging $1 million effort funded by state lawmakers, the college foundation, local hospitals and others. The goal: Add registered nurses, medical assistants and certified nursing assistants to a rural medical industry workforce on the North Olympic Peninsula that is typically starving for job applicants.

http://www.peninsuladailynews.com/news/one-of-a-kind-collaboration-expected-to-train-health-care-workers-on-peninsula/

A new kind of doctor’s office that doesn’t take insurance and charges a monthly fee is ‘popping up everywhere’ — and that could change how we think about healthcare – Business Insider

Interesting article after the previous post.

Direct primary care is a small but fast-growing movement of doctors who don’t accept insurance and instead charges a monthly membership fee.

http://www.businessinsider.com/direct-primary-care-no-insurance-healthcare-2018-3

The PA/RN/MD/DO will see you now. Consumer Reports

Good article demystifying the medical provider landscape. While I have some small issues with it, it is a good layman overview.  What they say about a seeing a P.A. “avoid relying on them for complicated procedures.” is quite off base. Many P.A.s work right alongside M.D.s in offices, doing all the same procedures that M.D.s do. It is more a matter of how long a P.A. has been working, and the background they came out of, just like any other professional, that determines there effectiveness on more complicated procedures. Some P.A.s came out of EMT work, and they are highly trained in some fields, some have spent extra years of education as orthopedic P.A.s. Some P.A.s have worked in the operating rooms for years, doing surgeries alongside the attending M.D. And the M.D. that they are assigned to is often relying on them to stand on their own and only bring them the more difficult issues. I’m sure there are many younger M.D.s who are still learning their craft and I wouldn’t want to take my complicated procedures to them either! I’d rather see an experienced P.A. than a brand new M.D. any day of the week!

It’s getting harder to see a doctor, but you can still get quality care from a host of other professionals if you know who’s who

https://www.consumerreports.org/doctors/will-you-see-an-actual-doctor-when-you-go-to-the-doctor/

 

 

 

Jefferson Healthcare Opens Express Clinic

Jefferson Healthcare has entered the new year with some positive announcements for primary care needs in the county. The Hospital district has announced a new Express Clinic, opening on February 5th. It will be open from 10AM to 8PM 365 days a year.

The goal is to provide same – day medical care for non-emergency health conditions, including minor cuts and injuries, mild respiratory, gastrointestinal and urinary symptoms. This is clinic is in addition to the normal primary care office.

The services provided will be billed at the same rate as your primary care clinic visits.

Patients will be seen in the order of their arrival and no appointments are available.

You do not need to be an existing patient of the primary care clinics to use this facility.  The announcement recommends that you call the standard clinic first, to determine whether you should go to the new express clinic or not. The new clinic will be staffed by Physician Assistants and Nurse Practitioners.  The hospital will phase out the old walk in clinic in favor of this new one.

This is all separate from the free standing Madrona Hill Urgent Care clinic that still exists on the first floor of the building at 2500 W. Sims Way, as you enter Port Townsend.

There is a huge shortage of Primary Care providers in both the U.S. and Canada. This is partially due to the fact that primary care Physicians make less than their counterparts in specialties so students often don’t follow that path. Insurance companies do not reimburse at rates that make the profession seem attractive. The push by government and insurance payers to reward the primary care physician for more wholistic patient health, while still refusing to allow the provider to attend to more than one issue at a visit is very frustrating to providers I’ve talked to.  It takes a dedicated young person to decide to choose that route, however it is in many ways extremely rewarding. It would be a very good idea for the government to offer incentives to students to go into primary care as well as revisit the issue of provider reimbursals, case loads and ability to investigate multiple issues at a visit.


 

Additionally, the hospital district has announced the addition of a husband and wife team of physicians. Chyrstal and David Schwartz have joined the staff.

Dr. Chrystal Schwartz has joined the Primary Care group and obstetrics. Dr. David Schwartz works at the Surgical Associates, specializing in general surgery and endoscopy.

This is not the first time husband/wife teams have been hired by the hospital.

 

Congress Is So Incompetent It Can’t Fund Health Insurance for Kids – VICE

The headline says it all. And the tie in to our local Hospital District is that this is likely to push us financially from black ink to red. And what were our local physician’s medical society doing about such a looming crisis, with more to come in the Medicare and Medicaid cuts? Were they coming out and deciding they were going to sound the clarion call and warn the population of the looming crisis? Ask them to call their legislators to ‘save the children’? Nope. They were getting together to  vote to endorse a man with no significant health care experience over a woman with a lifetime of policy and medical background. Just like the voters last year that voted for Trump, who is putting the local hospital in jeopardy by endorsing these cuts. Did these same physicians feel compelled to get together last year in the run up to the election to warn the population of the impending disaster that Trump likely would bring to healthcare at both the national and local scene? Nope. Have they ever endorsed a candidate before? Apparently not. But I digress, I’ll cover that tale of our local petty politics  in another post at a later date. Here’s our latest medical fiasco on the national level.

Last Saturday, Congress failed to reauthorize the Children’s Health Insurance Program (CHIP), jeopardizing systems that provide low-cost insurance for almost 9 million kids and hundreds of thousands of pregnant women in families that make too much money to qualify for Medicaid but still need assistance. Legislators failed to renew other safety net programs as well. But missing the window on CHIP was a particularly egregious fumble, and one of the clearest signals to date of how desperate this Republican-led Congress is.

https://www.vice.com/en_ca/article/pak4k7/congress-is-so-incompetent-it-cant-fund-health-insurance-for-kids