Thursday, June 7, 2012

Doctor's Handwriting... The Electronic Medical Record.

Okay, so 99.9% of what I put on this blog is intended to be educational for my patients, not opinion. But if you notice, I have a little topic "Ridiculous," and ever so often I can't resist putting a thing or two under that topic.

I thoroughly dislike the Electronic Medical Record as a general rule. They aren't uniform from practice-to-practice, so I still can't get other office's records easily. They make me sign all sorts of stuff that doesn't really need my signature but is required for some legal computer mumbo-jumbo reason (adding at least an extra 50 signature clicks a day, after I open each one and wait for it to slowly open to make sure it's not actually important). It bogs down midday and is useless if the power goes off. It freezes sometimes, causing me to restart my computer relatively frequently. It does not save time and in fact presses me to steal time from my patients so I can handle it's cumbersome ways and bazillion extra clicks. It does not add to patient care. It is bureaucracy and frankly garbage for the most part. What I dislike most about it is that it adds to the depersonalization of medicine. It makes me feel like someone looking over flight options for me at the airport after I missed my connection; clicking away to order labs and scan over outside notes as the patient is in front me, instead of just quickly glancing down at tangible paperwork or scribbling/checking orders to be done as we're walking out of the room together talking about their upcoming weekend for instance. It steals my eye contact, and makes me multitask more and more.... okay, okay. I'll stop there.

BUT, I do like these things about it:
-It makes prescriptions easier to create and send to pharmacies.
-It makes raw images of the brain, etc. easier to obtain/view personally.
-It makes looking through my own prior notes easier.
-It fixes the problem below.

The referring doctor below is one of the best primary care doctors around. This physician is thorough, caring, loves to spend time and talk with their patients, and go the extra mile for each patient.

And they are totally off the Electronic Medical Record system.

So I receive the note below, and from this note I am supposed to find out why the patient is sitting in front of me... awaiting my workup & thought processes as a Neurologist/subspecialist.
I whited/blacked out a few things to keep it anonymous of course.

Can you tell me why I'm seeing this patient? I couldn't for awhile. So I asked the patient, and they are mentioning blurred vision, back pain, neck pain, a funny feeling in a certain finger, incontinence.... essentially a bunch of stuff I could be seeing her for, but all of which her primary care doctor
may not want me to address.

So the clue is here from the bottom right corner, blown up for you:

I'll translate:

"consult Neurol - R/O alz"

---Or in other words:---

I would like to consult Dr. Kirk of Neurology to assess for, and hopefully rule out, the possibility of dementia, Alzheimer's type.

I can't give this referring physician too much of a hard time.... since I'm not willing to put my own handwriting up here.

Oh, and one more thing:
This note was faxed to me (the one digital intrusion into this primary care doctor's life)...
...why is
Greenwhich Mean Time noted?
I'm pretty sure someone in Tokyo is not going to be thankful that GMT was noted for this particular visit note.