Sunday, March 09, 2014


I have been a way from blogging for a bit - tried to clear my head a bit with a vacation skiing - left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3-day stint.  It was nice to notice that there's a whole world out there - beautiful mountains, fresh air, nice friends.  All things considered, I am pretty lucky to have a stable job, appreciative patients, and a fulfilling career.

But it didn't take long after my return to work for me to feel flooded again.  Two days after returning to work, it was like I never left.  Perhaps it's like that for most busy folks, but somehow the world of health care delivery feels more frenetic than ever.  The in-basket messages,  the mountains of results, the re-scheduled patients on top of those already scheduled, the seemingly endless phone and e-mail messages, the late-night consults after a full day of procedures - all demanding time - it's bordering on crazy.  I have several nurse practitioners who assist, but the volume of electronic patient care that's happening now is overwhelming to even the most computer-savvy of us doctors.

And all of this communication is not compensated.  There are no "RVUs" for answering an e-mail.  There are no "RVUs" for speaking on the phone.  There are no "RVU's" for typing.  No "RVUs" for data entry and clicking a mouse.  Physician time means nothing to programmers and policy-makers.

It's a larger symptom, I think, of the new "efficiencies" built into the electronic medical record (EMR) that has become ubiquitous with the world of medicine today.  Information flies so fast and there's so much of it that it's getting almost impossible for doctors to keep up with the screen responsibilities, not to mention their care responsibilities.  The EMR is no longer just an EMR.  The EMR has morphed into  a scheduling agent, pharmacy, reminder pad, calculator, care pathway generator, instant-messaging service, a procedure orderer-by-proxy (and guideline) and a patient messaging portal that, aside from a 400-character limit, provides unprecedented  access to physician in-boxes and schedules. There are so many buttons that they no longer fit on a single screen and the "allergy" field no longer can be displayed as it's pushed out of the way by the name of the patient's insurer.  Add to this the constant and growing influx of patients (thanks to marketing pushes and programs to spur referrals), voluminous administrative meetings, and growing CME requirements, it's no wonder many of us feel flooded.  I work later than ever now thanks to these electronic "efficiencies," then find myself waking in the middle of the night wondering: Did I call Ms. Smith? Did I miss something? Did I put that order in? When am I going to do those result notes?

I think I'm suffering from post-traumatic electronic overload disorder (PTEOD).

Oh sure, we could hire another guy or gal to offload some of the work - maybe even hire a wasteful manpower-intensive scribe like those that work in some ERs that click for cash - but that really won't help stem the ongoing barrage of information that is now pummeling physicians and their care teams at an unprecedented rate.  Sadly, I don't see this trend changing anytime soon - the business case for the EMR is just too attractive for hospitals and payers.  Still, with the prospect of ICD-10 and it's 71,924 procedure codes and 69,823 diagnosis codes (that must be paired correctly lest doctors not be paid) just around the corner, I fear that physician stress, burnout and PTEOD will only increase as we are force-fed this diet of electronic overload without any reflection of what its doing to those who provide the care.

Ugh.  I need another vacation.



UAB Neurovascular Surgery Case of the Week said...

Agree. Exhausting.

As in Ukraine and Venezuela it is time for an "EMR Spring".

Andrew_M_Garland said...

Our government is filled with followers of Saul Alinsky who are having fun with doctors.

They think "So, doctors claim to have the BEST interests of their patients at heart. Hah! We'll put them to the test. They will document everything, as in government, and will do it for free, because they care."

"We'll show them. In the modern, collective world, the rules, the paperwork, the hierarchy, and the quality measures matter. The people are only there as an object of the bureaucracy. People come and go, live or die, but the bureaucratic record is forever."

Doctors should push back hard against socialism in medicine. It is only in a free market that you can provide a great service, care, and be paid.

Now, your patient is your customer. Soon, he will be only a statistic in the great river of electronic records.

Paul Kempen said...

I would like to point out there will be a Webinar on March 23, 2014 and the particulars are viewable at:
1.5 CME credits are available and NO MOC Points!