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April 5, all medical records became immediately available to patients per law.
-Pt eloped from ER after reading no appendicitis
-MD got paged Sat. bc a lab was 0.1 low
-MD asked to modify record bc pt disagrees they are overweight
-Pt found out cancer had recurred w/ NO support 1
-Pt eloped from ER after reading no appendicitis
-MD got paged Sat. bc a lab was 0.1 low
-MD asked to modify record bc pt disagrees they are overweight
-Pt found out cancer had recurred w/ NO support 1
Patients could ALWAYS request medical records. I agree it should be free & expeditious. Having immediate access to them is making more unbillable work for physicians AND doing a disservice to patients who deserve to understand records with the help of the physician. 2
We are trained to give bad news. And how to explain which findings are benign/insignificant and don’t need follow-up. If left alone, pts get on Google and make the worst of everything. Results should never be released before a physician has seen them & planned for follow up. 3
Medical jargon in a history and physical is standardized for a reason. It helps us communicate with other physicians. While I agree that we should be considerate in our notes, being factual is important as this is also a legal document. 4
For example, we had a “frequent flyer” in residency who was often brought in by ambulance (BIBA) for EtOH (alcohol). I would never write he was “drunk,” but writing that he was “well-known to me for alcohol intoxication” shows that I am better able to assess his sobriety. 5
In fact, his favorite song was “Piano Man.” That was how I tested his sobriety. When he could get through several verses without slurring or forgetting words & walk normally, I’d type up his discharge. The new EHRs that discourage open text prose vs button clicking are awful. 6
Current EHRs were designed by hospitals to optimize profits & reimbursement from insurance. But they take the physician & nurse away from the bedside. Charting a sprained ankle takes at least 15 min. And whether they smoke or have a family history of lung cancer is irrelevant. 7
But you cannot override any of the buttons for fear that the chart may be “downcoded,” i.e. billed at a lower level. EHRs are so cumbersome that they hurts patient care bc they take too much time away from the actual patient encounter. I’d rather have that extra 15 min to talk. 8
My own physicians now chart with their back to me while asking me questions. And most of them tell me they have to go back after dinner and finish the charts. The result is a hurried chart with fewer details. I still don’t understand why office visits aren’t billed by time. 9
I guess I’m trying to say that we’ve lost the forest for the trees. We’re so busy charting what we did that we don’t actually DO it. Care is worse. Patients are unhappy. Physicians are unfulfilled. And CEOs of hospitals & insurance companies are on vacay in Bora Bora laughing. /X
Here’s an actual notification I got from my cancer center, MD Anderson, the last time I logged in. I’m dreading my 6-month F/U MRI. I want to get results from my physician. It’s easy to say not to log into MyChart but it also sends messages for appt reminders and billing.
