I’ve been slow to adopt new technologies for doctor such asn electronic medical records and electronic prescribing. I’ve been in the front edge of tech since the mid-1980’s, when I wrote my grad school thesis on a ‘Mac’ that had a full 128K of RAM. I got the upgrade to 512K as soon as it was available a couple years later. Back then you could put about 400 K of data on a disk, which wouldn’t be enough for a modern I-Phone image. But back then we compared it to text, to the weight of a stack of books. It was incredible.

When AOL came along in the 1990’s I was amazed to find an entire library of newspapers in my basement in Fond du Lac, Wisconsin. I eventually created web sites after a Go-Daddy Superbowl commercial picqued my interest. All you needed back then was Microsoft Publisher and a hosting account, and a unique name made the top of search engines. I bought dozens of domain names, which would probably be worth a fortune now that every 3-letter word followed by dot com sells for tens of thousands of dollars. I noted that psychiatry had the DSM, the DSM-II, the DSM-III, etc, and I bought the domains of DSMV, DSM-V, DSM5, and DSM-5, thinking I was really onto something. But I sold them after receiving a letter from attorneys representing the American Psychiatric Association saying I was violating their copyright. Not sure if they were correct after reading about people selling Coke.com and other domains!

But I am not a fan of electronic medical records for many reasons,. I never understood why a person must repeat his name, address, phone number, and whatever else to the familiar face at the doctor’s office, but lists of medications are almost in the public domain. For example, every single medication given or prescribed for me in San Diego is populated in the electronic records of my local docs. Years ago, patients who were prescribed Suboxone by me had those scripts show up in records held by their family practice docs. Apparently once one doctor knows your history, everyone else with an MD, DO, or APNP is entitled to the same.

And I’m not a fan of the templates used by most doctors to auto-complete their records to avoid problems with Medicare. Non-docs may not be aware that coding for Medicare reimbursement is incredibly complicated, and millions of dollars are at stake for any major healthcare system. In short, a visit with a patient could trigger a fee that varies widely depending on the number of organ systems examined or discussed, If a doctor looks in ears without writing it in the record, his/her employer loses money. Medicare fraud is not an uncommon accusation for participating doctors, and to Medicare, something that is not documented did not happen. So electronic records now come with templates that are pre-filled with normal values (ear canal had no cerumen and tympanic membrane was WNL – within normal limits). At least in the 1980’s we had to write it out by hand, although even then people joked that WNL stood for ‘we never looked’! Are electronic medical records good for patient care, or are they intended to protect careless doctors?

I’ve seen those systems abused many times. Even looking through my records over the past few months, I’ve read about many procedures where the ‘risks were described and alternatives discussed’, when in reality nobody talked with me at all before the tests. Last night, going through my chart, I read the preop note by an anesthesiologist who never saw me preoperatively. Given my background I wanted to ask a few questions, but that doctor never stopped by — although the note says we discussed the risks of anesthesia, my airway was examined to determine the difficulty of intubation, and I had ‘normal heart sounds’ (that were anything but normal to my cardiologist at that time).

I’ve seen that abuse so often in my private practice that I don’t believe anything in an electronic record. Heck, I’ve received referrals for stuttering and read the referrer’s notes that claimed, over and over, that speech was ‘normal’.

But despite all that, I recently bought an E-Prescribe program. More and more states are requiring it and I’m tired of hand-writing and mailing schedule II scripts. There is currently a shortage of ADD meds at least across Wisconsin, and if a pharmacy provides half of the pills in a prescription, the doctor must send a new written prescription to dispense the remaining pills if/when they arrive at the pharmacy. Now I just click a few buttons on my laptop.

What do you readers think about electronic healthcare? Do you like the push to telemedicine, or is it a COVID fad that will disappear like Beanie Babies? Personally, I like to see a doctor in person. I WANT the doc to put a stethoscope against my chest. Although my PCP listened to my heart at every appointment when I complained about dyspnea, and all of those records say my heart sounds were normal. Then my new cardiologist asked his assistant listen to my heart at his appointment because it was a great, obvious example of a ‘gallop’ heard during heart failure. Maybe in-person exams are overrated.

Shifting gears, it was hard to look through my online chart last night and read how sick I was. My labs, my pressures, my regional blood flow and cardiac output… they were all horrible. And I felt pretty sick, unable to walk 50 feet without resting. But I passed muster at all of my doctor’s appointments. I have to wonder if the docs from the old days who had nothing BUT stethoscopes would have discovered my illness sooner.

It was unsettling to see how ‘off’ things were. My wife would say ‘why? you’re better now!’ (I think those were here exact words). But it was hard reading, and it left me… sad? Or maybe frightened? It was disturbing to realize how quickly a body can stop working. When I was a senior resident in anesthesiology training I had a new resident under me, sitting at the head of the table while I stepped out for a moment. He was scared to death, and I told him ‘don’t worry – as long as you keep oxygenating him it is almost impossible for something bad to happen.’ People always seemed so hardy to me. Now, I feel as if I’m at the edge of falling apart.

On the other hand, my electronic medical chart says that I’m doing very well!

Categories: Science

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