Un-Meaningful Use

I think I almost have my computer fixed. I threw it accross the floor doing the G+D<<< Electronic Medical Records. These record systems are all build backwards and are geared towards what the government wants and not what is best for and how to take care of patients. My favorite is that they automatically report to the government the patient's use of tobacco and their body mass index! That is just the tip of the iceberg. They also record other demographic information and send it as well, such as race, sex, etc. Medical charting which at one time was used to help you take care of the patient, is now something that is done to the detriment of the patient. The patient comes in and you do your best to take care of them and then generate a computer driven bundle of initelligible drivel that no one can read, much less understand why the patient is there, thats only purpose is to comply with government mandates and by way of such what the insurance must have.

Next time you go to your doctor for that rash, just think, your BMI is being sent to the FEDs!

The Seven (deadly sins) Entitlements

It slowed down a little bit last night in the ED, at least in terms of the "real Emergencies". There was still the late night cohort of the STDS, low back pain, you know, the usual. At the window was a man in his early thirties screeming at the triage nurse that he was disabled and how dare those others go back before him. I dont know why but somehow all the protestors who are in Wall Street popped into my mind. This guy is screaming that he deserves and is entitled to things because of his (deadly sins). He is envious of other going before him, he is drunk and morbidly obese, he is definately full of wrath, turns out he had a STD. Watching the Wall Street protestors, it seems almost the same thing. They are full of wrath, they dont want to work for things, rather they want it given to them, their gluttony is that they all have laptops and iphones, they want it all!, they are envious of those who have achieved, their pride is that they believe that they are entitled to what they lust after.

Locutus of Borg

Just like the others, we are being forced to be assimilated by CMS with the mandate to go to electronic medical records. I have named ours Loki after the norse god of discord and mischief because it has pretty much destroyed our practice and ability to practice medicine. With out embelleshment, so far the EMR has decreased our productivity by 45%, doubled patient wait times and cost over 92K/physician to implement. Worse, it is still not running correctly. The touted improvement in the ability to take care of patients is not there, nor is improved office efficiency. All it seems to be able to do is create thrirty page reports to comply with the Federal Governments "Meaningful Use" demand.

I though we were the only ones who felt this way but then I started the whole conversation in the lounge at the hospital. There was not one doc who liked the things. On the average, they all have seen the same thing. Thank you Fed Gvt.

The Go To Light

I was called in to see a patient in the middle of the night. As I was checking on them a code was called on the floor I was on. With great concern I poked my head out of the room hoping to see someone else in a white coat looking like they knew what they were doing going to the room where the code was happening. No such luck! I went over and started doing the doctor thing. Airway, tube in, pump chest, push drugs, pump, pump. In the middle of it all, it was pretty dark in the room. Someone recognized that fact and hit all the switches. There over the bed was an exam light that was stronger than a landing light of a 747, I mean it was blinding. Soon as it turned on we all had to squint. Someone in the back said, "dont go to the light"! We got the patient back, PEs suck! I couldnt help wonder how many of those "I saw a white light" stories where those darn exam lights.

Phone Solicitors

One of the hardest things about being on call, is all of the phone calls. Our answering service does a great job telling patients that we can not diagnose over the phone or call in prescriptions after hours. It also tells patients that if it is an emergency they are to go to the nearest ER. Lastly it tells then that we are on call only for acute post-operative problems. So, what happens? They lie to the service and we get called. Many are drug seekers, many hope to call when the office is closed so they wont have to come in.

Here are some of the latest. A patient called stating that he had surgery and one of the doctors was supposed to call in an antibiotic and that he had just called the pharmacy twice and it had not been called in. I asked what kind of surgery he had and it wasn't the kind that doctor even did. I then asked for the pharmacy number and he said he didn't know it and would have to look it up. When I reminded him that he said "he just called it twice" he hung up.

Another person called and said that they had surgery two years ago and now they were having a bad headache, could we call in some percocet?

Three were calls from people who thought they were getting a cold, could we call in an antibiotic. (two of these were after midnight!)

I had two calls last night from people who wanted to set up an appointment at some time during the month.

I know I have talked about this before, but I just had to vent.

Rule number two

I was doing rounds and right next to me one of the critical care attendings was also doing rounds with his posse of fellows, residents and medical students. He is a very brilliant, quite person who I had never heard crack a joke or even change his expression. A young intern was explaining that the patient came in with sudden mental status changes and fever. They had done a spinal tap which was bloody but did have some white cells. The attending asked what the next tap showed, the intern explained that they only did the one. The attending looked right at him and said, always remember "rule number two!". I cracked up. He looked right at me and grinned, I explained that I had better run, "you know, rule number one!" Only the medical students seemed to know what we were talking about when one said that he knew where there were some twinkies!

Cyber Staph

I knew it was going to happen sooner of later, but I was surprised how fast it happened. Ive heard about computer viruses but now we have computer bacteria. We had an uptick in the number of nosocomial infections on the first floor to have computer order entry mandated. Most of these were staph. After an exhaustive search we found the source. It was of course the computer keyboards that were used to enter all the orders. It appears that once the keyboard is contaminated it is rapidly spread because people have to keep going to computers to do anything and before you know it, the staph is spread everywhere. Worse, there is no way to clean and sterilize the keyboards. The touch screens were worse because they seem to keep a static charge that attracts all the floating dust and bacteria to the screens! One of our administrators suggested that all computers becovered in one of those keyboard plastic things, but when I mentioned the tough screens he blew me off. I saw him later sneeze and cover his computer with mist!