Ever wonder why so many doctors today have such negative attitudes about their jobs, why so many are retiring early, and why so many wouldn’t want their children becoming doctors. I thought becoming a doctor was synonymous with success? So why are these highly successful people, today’s doctors, not smiling? One word, computers. Specifically, I am talking about the introduction of the electronic medical record, also called EMR, into their daily lives. Say the letters EMR to most doctors today in the US, and stand back– you will get a very strong emotional response. Today, a pediatrician’s day is spent almost entirely with a computer screen and keyboard. Because of this sad fact, I am going to do something that I have never done before in my six years of blogging, I am going to weigh in on some of the choices our governmental leaders, our computer scientists, our insurance executives, and our pharmaceutical executives have made in shaping today’s healthcare system. I want to pull back the curtain a little and let my listeners get a feel for what today’s pediatricians are up against as they go about their day to day jobs and maybe start a conversation about improving things.
Out of Control Healthcare Records
I want to believe that the architects of electronic medical records were well intentioned. The current emphasis on documentation, coding, and safety regulations however, have drastically changed the focus of outpatient pediatric care. The EMR and the computer are literally sucking the life out of today’s doctors. Onerous hours of data entry are not what we signed up for in med school, especially when those efforts only marginally improve healthcare delivery. Exhibit A of a process that is out of control–just take a look at the EMR of a one year old that was recently seen in my office who had undergone a serious surgical procedure. Granted, surgery is a big deal but look at the resulting medical records. This stack of papers represents a paper copy of this child’s electronic medical record! Of course, the pediatrician who was seeing him for his first visit to our office had 15 minutes to not only review his medical records, but to also to complete his one year medical visit with all the requirements that that entails. I think you can see that this is impossible to do. Asking doctors repeatedly, to do things that are not possible, will quickly make them cynical and angry. That is, in fact, what we see happening. I am afraid that healthcare administrators, computer engineers, insurance companies, and government bureaucrats have created a system that has lost sight of the real reason for healthcare; the face to face discussion and decision making regarding our children’s health and how we, as their healthcare advocates, can improve their health and ultimate well being. Creating voluminous medical records is not our mission.
The Data Entry Reality
When I began in medicine just a generation ago, 95% of my day was spent on face-to-face healthcare with patients, and only 5% was spent with billing and creating medical records (what I call “process”). After the introduction of the EMR however, I calculated that I spend closer to 66% of my time on patient care and 34% on process. Some days, I spend as much as 50% of my time with process. Our primary mission, however, should not be to create medical records but to take care of children and families.
I certainly can see the need for improving data collection, improving patient safety, and making healthcare more accountable and efficient. I support these goals, but I don’t think that achieving them should come at the sacrifice of our true mission: providing the CARE in healthcare. I think something is out of balance when data entry, generating medical records, and insurance coding take up to 30-50% of a doctor’s day. I think that system is shortsighted; I think we will regret these choices as we look in the rear view mirror of time. While today’s doctors are busy creating the greatest medical records the world has ever seen, today’s children are losing out on what doctors do best, providing care.
Thanks for listening to my complaints about electronic medical records. I promise I won’t do it again soon but I think it is important for families to understand why their children’s pediatricians may be out of sorts at times. These are talented, dedicated, people who work hard who have undergone a drastic change in their job descriptions in the past few years. If you enjoy hearing about what is new in the world of pediatrics and child health, take a minute to subscribe to Portable Practical Pediatrics at www.docsmo.com or on iTunes. This is Dr. Paul Smolen, you know Doc Smo, hoping that despite your doctors trials, they remember to give you some smiles. Until next time.