The medical chart is coming to an end. Here’s why.

“Dr. Sevilla, I have a question for you,” a patient asked me this week. “I’m going to tell you something, but I DO NOT want it put in the chart.” Hmm, I asked myself, can I really do that? It’s the patient’s wish, right?

The patient went on to tell me that she heard about this week’s story about a hospital network being hacked and 4.5 million records being stolen. “What if that was my information?” the patient asked. “Does that mean that information in an electronic medical record could be out there for anyone to see?”

“How do I know your server won’t be hacked?” the patient went on to say. “Doctor, what if I asked you to not put this in the electronic record, and to put this in my old manila folder paper chart?” Can you imagine the disruption of trying to maintain a digital chart, and also going back to maintaining a paper chart as well?

Much has been written about the inadequacies of the digital medical record, but as more and more digital medical records breaches occur (and I’m not even going to touch on the security flaws of Healthcare.gov), how comfortable will patients be in giving medical and non-medical (i.e., financial) information?

Just a few observations on why I think we’re coming to the end of the utility of the medical chart:

Loss on the story and narrative. Back when I was a first year medical student 20 years ago, the most important thing was recording the patient’s story in the medical record. For example, to be as specific as possible in who, what, were, when and why the patient was having their symptoms. In today’s digital world, when I read a medical student or resident note, it’s like reading Twitter. Very brief, vague, and not really that useful. I think we, as medical professionals, have lost the art of telling the story of our patients because of the digital record.

The medical record as a source of billing and false accountability. Now, I’m not the first person to say this, but the medical record has become a place, literally, to check the box and less a place to really come up with the solution for patients. Many believe that the electronic medical record is a way for “big brother” (whomever that is) to keep an eye on clinicians, and eventually find a way to compensate less. My cynical mind is slowly (and reluctantly) agreeing with this point of view.

Security breaches will become more and not less frequent. I predict that there will be a coming wave of concern to the point where patients will insist that certain medical data not be recorded in the electronic health record. What will the clinician do at that point? Do we follow the “patient-centered” model because that is what is being emphasized now? Or, do we follow the medico legal fears and record it anyway for fear of being sued for an incomplete medical record?

Of course, I’ll have comments and tweets telling me I’m overreacting. And, still other tweets telling me that they have been saying things like this all along. Is this the future of medicine? Is this the future of medical care in America? This is not what I signed up for, and I’m mad, and sad, at the same time. All I wanted to do is take care of patients, and hopefully have an impact in their lives. It seems more and more that is becoming more difficult.

Mike Sevilla is a family physician who blogs at his self-titled site, Dr. Mike Sevilla.

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  • Daniel

    While anecdotal evidence is hardly the best source for information about broad trends, my experience with “telling the patient’s story” is directly contradictory to yours. Working at an ED in an area where multiple hospital systems are transitioning from paper to electronic charting, I have gotten to see many examples of both types of documentation, written by physicians ages 30-70. What I have seen is that paper charting is frighteningly useless; writing takes more time and space, resulting in charts composed almost entirely of abbreviations and often reduced to complete illegibility by infamous physician chicken scratch and image degradation from faxing. The only components that are consistently legible are the check boxes, which are just as ubiquitous as in electronic charting.
    Speaking of which, I have actually observed that charts written by younger physicians are more detailed and less likely to contain sentence fragments than those of older physicians, perhaps more a result of their greater comfort with typing than of either age group’s charting ability.
    Regarding your final comment, no, this is not the future of medicine in the US. This is the future of the world. Technology and electronic media in all their forms will continue to increase their roles in our daily lives, and for the medical field to turn its back on the progress of the world would only widen the perceived divide between physicians and their patients.

    • JR DNR

      This fits my paper records for the past 10 years – completely illegible for the most part, my current doctor had to ask me “why did they run this test??” to me, and of course I don’t know…

      At the same time, I wholeheartedly agree with the “please do not put this in my chart” request, and have requested that myself before.

    • Eric Strong

      I completely agree. I understand people’s frustration with EHR, but movement of medical charts into electronic format has greatly improved their usefulness to other doctors. Routine clinic notes in paper charts from 10-15 years ago were worthless as a result of brevity and illegibility. Also, proper note writing and documentation is more formally taught in medical school now than in previous generations. Overall, it has also been my experience that the quality and usefulness of notes in the medical chart has only increased with time.

      Increased data breaches are a big concern however, and I do empathize with patient’s concerns. The obvious solution to maintain an EHR and provide maximum security would be to keep the EHR off a network – make it literally impossible to access from outside the physical clinic. But I suspect the enormous downside of this approach would outweigh the benefits to information security.

      • Ladyimacbeth

        The problem, though, is how many more people are now withholding information from you out of these concerns? I don’t want to withhold information from my physician, but because of these concerns I’m doing it. I think this is going to increasingly be a problem.

  • Ladyimacbeth

    Well, I don’t think you’re overreacting. I have already withheld information from my physician due to concerns about the numerous security breaches in the news. If patients realized how common these are, they would think twice about what they shared. At least with paper records, the number of people who could access the records was much more limited. Now, we have to worry if a medical student is going to leave our information on a flash drive at Starbucks. Ugh.

    • Kristy Sokoloski

      I find your statement about saying that “at least the number of people who could access the records was much more limited” to be very interesting. The reason is because I have not found that to be the case. Before a number of my doctors’ offices had switched to the electronic record of course they had paper charts. Well, every single staff member of their offices had access to that chart either to put lab results in, or other types of things in the chart such as letters from referring physicians to the Primary Care Physician stating the result of consult and/or treatment plan. Also, same with putting in the chart when prescriptions have been called in or the patient called to leave a message asking for something or a question about treatment. So, it was not as limited when it comes to access. Also, a paper chart if left open for all to see (and I caught it at one of my doctor’s offices that this happened) someone who does not have the right to look at that patient’s chart is going to look at it too. In the hospital setting when it came to paper charts every single person in the hospital dealing with the patient had access too. So, I am not sure what makes it any different. In either case, whether paper or electronic chart tons of people are going to have access to the chart.

      • Ladyimacbeth

        Yes, everyone in the office with a paper chart, but not thousands of people in China which can be the case with an electronic record. That’s the concern I have with electronic records is that they can be spread to so many more people- and that is already happening. They don’t have to tell you about it unless I think it’s 500 patients that have been affected. Then, they have to send a letter out.

        • Eric Strong

          There are certainly ethical questions raised by data mining electronic health records without explicit consent.

          But as far as hacking records, from the perspective of a single individual patient, it’s much much more likely for a person in the medical clinic to get nosy about his/her paper chart than it is for a random hacker abroad to care whether some unknown foreigner has some disease. When health records get hacked by the thousands (or millions), it’s to gain access to billing information. No one cares whether or not you, specifically as an individual, have diabetes or what your last colonoscopy showed. It’s just about financial fraud and stealing money. That doesn’t mean it shouldn’t concern us. But we should make sure our concern is appropriately placed.

          • JR DNR

            I was telling my doctor about being laid off, and what I was doing to get a job… and realized my doctor was documenting it in his chart. I asked him why and he didn’t explain, just hit the backspace button…

            I mean, I am not really concerned if someone knows my TIBC score, but I really don’t want non-relevant personal information being written about.

          • rbthe4th2

            I’ve had this happen.

          • Ladyimacbeth

            I think my nervousness about it comes from working in a hospitals where there have already been security breaches. One nosy employee just feels a little better to me than knowing that my record is one of hundreds that was compromised. Maybe that’s not rational, but it just feels more contained with a paper record. I know electronic records are here to stay so I’ll have to get used to it, but it has altered what I share with my physician and I hate that it does. I read about Practice Fusion and data mining, then I go to my doctor’s office and realize he has Practice Fusion. It doesn’t make me feel too comfortable talking about much of anything knowing that it’s going god knows where.

        • Kristy Sokoloski

          Those paper charts can be hacked in to as well if someone breaks in to the doctor’s offices. And medical information was getting sold all over the place even before EMRs. And yes, that is correct that it is easier to share data in an electronic format. This is especially the case if someone’s chart is super thick. I have several paper charts like that. And paper charts can still get in to the wrong hands, even around the world or when someone moves across country and has to have the records mailed or faxed to another office.

    • JR DNR

      I know people who have been hired as temps to go through patient paper files and organize them.

      • Ladyimacbeth

        Oh, I know there were (and are) security breaches with paper records, but it is much more widespread with electronic records. More people have access.

        • SarahJ89

          The practices in my rural area are now all linked in a 30-mile radius so I no longer have to worry about one nosy person in the office, but many people in other towns. Many more people are now authorized to have access to my records than ever before.

          • Ladyimacbeth

            Yeah, I hate that. That’s one of the things I’m trying to prevent with my records. My dermatologist has been successful at treating me from age 14-42 without having any gynecology records, and I’m not sure why they would suddenly need them now. They’re determined to strip us of any privacy in the name of “holistic” (gag me) care. I purposely avoid physicians in the same practice as my gynecologist, because I don’t want them having my records – nothing scandalous in there, it’s just not necessary for them to have everything.

          • SarahJ89

            I usually go off the reservation for any specialist consults. For starters, I think of a consult in the singular, a one-shot visit to gather an impartial opinion, not the beginning of an ongoing relationship. I’ve also noticed that the net effect of any specialist involvement within the hospital/EMR network is the gagging of my PCP. They become so fearful of stepping on the toes of the (not so) Great Oz that I can no longer get honest feedback and advice.

            The bottom line for me is: It’s my body, not Corporate Meds. Too bad the doctors are in the middle of this tug of war.

  • EmilyAnon

    After I was diagnosed with cancer 10 years ago, I suddenly started receiving unsolicited healthcare related mail. Most unnerving were the ones from the Neptune Society and cancer related organizations asking for legacy donations, with specific instructions how to word it in my will. After a while it stopped, but when I recurred some years later, it started all over again.

    10 years ago paper records were still in use, so i don’t think my medical information was hacked, but rather sold off by the hospital.

    • guest

      The same thing happened to me 21 years ago when I became pregnant. About a month after my first prenatal visit I suddenly was deluged with junk mail for baby products.

      I doubt that my obstetrician’s office would have dreamed of selling my information to direct mail marketers but I’m pretty sure that my insurance company would…

  • Ladyimacbeth
  • Lisa

    I’ve seen a few specialists once or twice, but for the most part I see of my doctors (oncologist, orthopedic surgeon, general surgeon, gyn. podiatrist, pcp) on a regular basis. I have seen the same dentist twice year for 33 years. I’ve read my medical records and there is a lot more in there than CYA.

    I don’t know what kind of medicine you practice, but if you are only seeing patients once of twice it seems something is wrong – unless you are an ER doctor.

    • SarahJ89

      I’ve seen my “official” doctor exactly twice in ten years. It’s not that uncommon. I have friends who’ve never met “their” doctor. We see a succession of “mid-level” providers. Since all the practices in our area are own by the same hospital, changing “doctors” makes no difference.

  • SteveCaley

    As a deeper question Cui bono – who benefits? These arguments are hardly novel or subtle. How is it that they cannot be heard?
    One area of outrage – possibly a manufactured outrage – was that physician charts were once notes – factual, encoded cues that required a physician’s experience to interpret. Interpersonal physician-to-patient and physician-to-physician communication was often verbal. The structure was that of a complex and terse private code. I do not believe that this was by accident; encoding things by symbol is a common method of creating a sub-dialect which is not easily interpreted by the average observer.
    Now, with the electronic narrative and check-box system, the documents are far more easily parsed; and with the regulations by the various authorities, the information is much more broad-based and tangential to medical utility. Certain abbreviations are banned, such as “QD” and must be written out, due to absurdity. The Rules say that “QD” can be mistaken as “OD” and the prescription “Take pill once a day” might be mistakenly read by the pharmacist to be “Take pill by inserting in your right eye.”
    The complexity and subtlety of information is largely rubbish to the practicing physician, but is solid gold, when it is viewed as Humint and psychological inferences to be made about people’s minds, attitudes and inner workings. A person’s history ten years ago of successful detox from heroin and methadone maintenance is of interest to the physician only regarding the patient’s increased proclivity to addiction; if they are abstemious, it is only of passing notice. But it is of incredible utility to someone wishing to probe the thoughts of this person, and even more so if one wishes to blackmail them.
    Is there an actual ethical breach to physicians’ gathering information beyond what THEY THEMSELVES believe is immediately medically useful?
    If patients and doctors believe so, the records will become more and more bogus. Any fool can tell what the ‘politically-correct’ answers are.

    • DeceasedMD

      I believe that the data mining that occurs in EHR’s by the MIC is shared with non covered entities of HIPAA by deidentifying 18 pieces of data (name, SSN, address, etc.). That medical info is shared and very useful say for Big Pharma to look at prescribing habits etc. The problem is that in this day and age it is pretty easy to re- identify people via multiple sources. That is what I think everyone should be concerned about more so than nosy medical personnel in the hospital. Your data is their way to the bank. Recent 60 minutes says that there are billion dollar companies that data mine and pretty much know everything about everyone: age sexual preference, medical history, religion,…the list goes on.

      • Ladyimacbeth

        Yeah, that’s what concerns me most.

  • JR DNR

    I don’t want anything in my medical chart that is personal. I share that information with my doctor – not with my insurance company, not with my employer, not with a court case that is requesting my records, not with the other medical staff at the office… no, I do not want that information in my records.

    • southerndoc1

      If you expect your physicians to file a claim for your office visit, the insurer has access to EVERYTHING in your medical record. If you don’t like that, pay cash.

      • JR DNR

        Which is why some things should not be charted.

  • Brailleyard

    I’ll give you 2-outta-3,
    As a former scribe and current medical student I can comfortably say that my notes ( and the notes of those on my team) are considerably more detailed than they would be if I was writing – ( I type at a considerably faster pace than I can scrawl/flip through binders) –

    As far as the latter two – Shucks. I remember watching the flippancy with which some physicians clicked boxes, but I also remember that it was an exception – not a rule. May I be proven right as these last several years continue.

    Security breaches – As hospitals/EHR’s begin partnering with the companies that have figured out digital security, I imagine hospitals will enjoy the security that banks provide customers. While a bank hack is not unheard of, it is rare – and rare enough that most of us are still comfortable with online banking/online credit card management.

    So, where’s the hope? – it lies in the fact that we’re still in the growing pains – digitally savvy residents are chosen by staff that may have cut their teeth on paper charts. college-age scribes are working alongside seasoned physicians. Outside of the hackers/criminals, I imagine that we’ll see quite a different world in ten years than Dr. Sevilla has suggested.

  • SarahJ89

    I no longer confide anything to my doctor beyond the bare bones of an immediate problem, thanks to privacy concerns.

    • jpsoule@hotmail.com

      Doctors and all providers have the option of documenting that which they choose and not. They also have the option of keeping private notes and records about any incident they believe are highly private or may lead to legal action. These notes are admissable in court in case of malpractice suits, though rarely needed, as such information sticks within your mind without notes.
      I have had many a patient confess activities only AFTER I told them I would not record it.
      Usually substance abuse, infidelities, STDs, etc. necessary to know in their total care.
      If your doctor will not or can not do this for his patients…

      • SarahJ89

        I have asked my NP to not put certain things in the record and she’s been fine with that. Nonetheless, the presence of the corporate third ear in the room and the fact that, unlike paper records, digital records leave the office casts a chill upon the conversation. There’s only so many times you can ask someone to keep a conversation confidential.

        • jpsoule@hotmail.com

          Yes, worked for corp med once..Sadly they own the doc, PA and NP, and can break you professionally.
          They are very good at ridding the system of those who do not ‘go along to get along’.

          • SarahJ89

            All bureaucracies are very, very good at getting rid of people. Often the person doesn’t realize what is happening. They hand out assignments that are draining, impossible or that they know the worker hates. Letters in the personnel file (three and you’re out). Harping on minor infractions, removal of minor perks.

            I’ve seen staff in agencies play these games to rid themselves of time-consuming clients. One of my supervisors parlayed this strategy into a position for which he later admitted he was woefully unsuited. He’d draw up a plan he knew the client wouldn’t agree to, then close the client out as “unco-operative.”

            Large medical corporations treat their staff and patients no differently.

          • jpsoule@hotmail.com

            Agree. That is why we all have to have, and teach our children to have the guts, education and training to make it on their own.

      • Ladyimacbeth

        I’m glad you do that, because I think patients want to be able to tell their physicians these things. They’re just afraid of where it’s going. I miss the days when we had a little more privacy. Sigh…

  • rbthe4th2

    I would think that the chief complaint of fatigue is not eating and drinking properly (too much Coke, too much McD’s), not exercising, etc. before depression.

    • JR DNR

      Fatigue is a common symptom of autoimmune diseases, and one of the early signs. Autoimmune are much more likely in women then men.

      I also make a distinction between sadness or grief (a loss) and depression (feeling down without an ability to feel good, and not associated with a reason to feel sad).

      I think depression and fatigue are signs of illness, even if the underlying illness can’t always be found.

      • JW

        You’re smart.

        • JR DNR

          I’m the third generation in a line of women who suffer from overwhelming fatigue – the get home from work and fall asleep kind.

          Since being diagnosed with Celiac Disease, I have ALL THIS ENERGY! Is this what NORMAL people feel like? EVERY DAY? Seriously??

  • jpsoule@hotmail.com

    Had an 80 something lady in the hospital for pneumonia. On rounds that day she asked me (rightfully so), why I ordered a barium enema X-ray on her, early that morning.
    I told her I never ordered that, and then the nurse told me they got the wrong patient that morning, but it was OK, because they got the right patient later….
    Makes one sick.

  • Kristy Sokoloski

    With how fast copy machines are today it would be easy to copy the charts of thousands of patients in a hurry. It is not as time consuming as it was 20 years ago or even 43 years ago (when I was born) thanks to the faster pace of things. You say that they have to do with electronic medical records is to leave their laptop in the car and the laptop is gone. True, but the same could be said for paper charts if put in the wrong places or got in to hands that are not authorized, that charts could just disappear. Remember Hurricane Katrina? Thousands and thousands of medical records were destroyed by that hurricane so all those people that were getting care there in New Orleans basically now had no medical records for doctors to work with if being cared for when it comes to chronic medical conditions.

    And as for the data mining, well, that’s been going on for quite a long time which is why it says in notices such as those tied in to HIPAA that some information from medical records is used for other things besides regarding our care. And that includes information from pharmacy chains to tell us about new medications on the market, or like I had my pharmacy do about 2 months ago: make the pitch to me that I could have my doctor write a script for 90 day supply on some of my medications that I pick up there in the pharmacy so that I wouldn’t have to go to the pharmacy every 30 days. Now, how did they know to make that pitch to me (the corporate headquarters that is)? Because of my medical record with the pharmacy (even though yes, I know it’s a pharmacy record). I have had marketing of drugs to me before even with the paper chart and records.

    Paper charts can easily get lost and when they get lost and someone goes to the doctor the office had to create a temporary chart until they could find the actual chart. And sometimes that did not happen. In the case of situations like what happened with Katrina as I said records can get destroyed and they have to start all over again. With electronic medical records, charts are easily found because the office also has a system back up somewhere so that even if the computers and such are destroyed by natural disaster the records can still be found. I am not saying that it’s the most perfect way to go but it’s better than the paper chart system in a lot of ways. Every system is going to have its faults and benefits. I have spent many years dealing with the healthcare system including on the patient side so I have watched as the transition from paper charts to electronic medical records has taken place for some of the practices. One of my current doctors their practice was already EMR before all this as was soon to be ex gyn. I thought it was interesting that they were ahead of their time on that one. And even about 30 years ago I thought that electronic medical records might be something that came up in the future. And it was something interesting to think about what could possibly occur when I started seeing computers become more commonplace. I was 11 years old when computers first started coming in to the school system. Yep, that was in 1983 (the spring of that year). It’s amazing how things have changed since that time.

    I do understand why you are concerned, and I respect that. My point is that regardless the system that is used there are going to be problems. And I don’t blame you for wanting to watch what you say but that information even with a paper chart could have been such where it could have gotten out to others like I mentioned before about what happened in the office where the chart was left open. And if a family member of that patient happened to also be a patient of that practice and then saw that then later asked their relative about that would have created a lot of problems. That would have included the doctor possibly getting in to trouble for violation of privacy just because one of his staff members didn’t keep that chart closed and didn’t put it somewhere that just anyone could potentially say.
    You are definitely doing what you feel is right in order to protect yourself although unfortunately nowadays nothing is that private anymore. Too bad that it’s like that. And we see this being the case on so many levels, not just for a medical record. So I commend you for that. I have enjoyed the discussion with you.

  • jpsoule@hotmail.com

    It is amazing to me, what persons other than me can and do record in the medical record.

    • meyati

      The Dr or corpsman would say- Miss, You aren’t Chief Johansen? “Of course not” “He really needs this in his chart now or delivered to cardiology” “OK” “Your husband is in security-if you can’t take it, would you take this to your husband? This can’t be lost” “Of course” It was put in an envelope with the Chief’s name-ID# and cardiology. After we left pediatrics we trotted over to cardiology. “Oh thanks, we’ve been looking for this lab work.” I’ve had this happen at Army and Air bases, where my husband wasn’t part of the staff.

      Another advantage to paper charts was that when I went to a doctor that nobody liked-he pretty much wrote up that women were crazy and ordered lots of painful tests and lots of hysterectomies. I had a fight with one on my first visit. I took my chart back and a Sgt opened it up- looked at it and my tears- and he tore the page up, and gave me a lecture that I was the one responsible for myself. After that i checked my chart and ripped pages out. Like if a doctor propositioned me-they’d put in that I made the advance-usually a new doc. The medic or corpsman would flip the chart open and say- you don’t want this doctor see this. I”d look-turn red-while the medic went out and began asking the doctor questions, while I tore the page out and tore it up in the bottom of my purse. It was my job to make sure that it didn’t end up in Chief Johansen’s chart.
      My EHR, they don’t even have that I have an aggressive incurable cancer for the nurses to see The nurses and staff can’t even see that I have a DNR. I can’t even protect myself. I can’t count on others to have the necessary data to protect me. Why would I want to be brought back whatever to die from this. Even at a civilian facility-I took a red crayon and wrote “RSD” on the front of the chart-then Drs, nurses said-You have RSD- I said–YES They looked at it and said-show me. I flipped in the chart to those notes and tests. They said-Good and treated me kindly-and tried to touch the area extremely gentle.

      • jpsoule@hotmail.com

        Please share with everyone what “RSD” is.

        • meyati

          Reflexive Sympathetic Dystrophy–It’s nerve damage caused by trauma-Mine is actually CRSD because they knew exactly what the trauma is. It’s a major problem for vets injured IEDs. It’s also known as the “Suicide Disease” because of the high rate of suicide. It’s also the second medical condition that was approved for the patients to have a morphine pump implant. It is extremely painful along the injured nerve and usually affects a quadrant of the body. It actually disfigures that part of the body and spreads. You get like horse hairs, then they fall out, and your skin gets slick looking, the body temperature changes, The skin becomes red, then blue, and then black. Joints twist up causing arthritis, You get gross swelling, while the muscles waste. I had 3 fingers that were black and flopped. I could only sleep about 3 hours at a time. My hand was red and black. If anything bumped my hand arm, or chest I cringed. I still have arturritis in my right shoulder, elbow, wrist and hand. It’s from the muscles tightening up-contracting. They try heat packs and surgical grade painkillers-that didn’t help, and it was spreading fast. Many surgeons do surgery-which gives relief for a few years, Gabapentin helps some people, then they have nerve blocks. After a very good insurance picked up the bill, we still owed $8,000 for six weeks of nerve block-3 weeks were spent trying to find one that worked.

          When a nerve block works, your throat becomes paralyzed-at least I had mine in my throat- I couldn’t talk, I had to keep my head elevated, if I had tried to drink anything, I would have choked to death-Once a drool or sinus drip got in my throat several hours after the shot, and I thought that I might be dying-but the whole body kicked in and I was elevated enough.

          This was from a breast biopsy that I was forced into. The military and insurance company told my husband that the whole family would loose medical coverage. I knew nothing was wrong. The biopsy was negative, but they slashed a nerve. This ruined my marriage. Sex was just about impossible, as my husband kept grabbing the ruined breast, and the pain came back for a week or so. The VA used Neurontin to control that pain. The VA is using nerve blocks on the disabled vets. It hurts so much to move at all. I began lifting 1 lb weights, and that forced my fingers to move. I had control of only my thumb and the finger next to it. It is horrible. The anesthesiologists said it was moving interiorly, I was already having trouble swallowing, and they said that it was beginning to affect my breathing. I had to learn how to write again, etc.

          This is one reason that I get scared easily, I’m suspicious of medical procedures, I’m scared of wars on diseases. I’m also very cynical. If I didn’t have thyroid problems and RSD, i wouldn’t go to a doctor. One time I was going around a corner of a building and a kid ran into me, I fell and my chest landed on some rock landscaping. It took about 6 months of Neurontin to get back to normal-which is always a constant nugent of pain- @3.

          I wish that mammograms had never been invented. I wish that I never had one. I humored my doctor and went into a civilian center and had one done of my other breast. When I came out-Someone yelled- Here’s that crazy woman that had a mammogram done on only one breast- patients and everybody came out in gowns and laughed and called me stupid. This was with supposedly strict privacy laws. I will never willingly submit to such humiliation again. I have a good GYN that doesn’t even try to touch that breast- he saw the scar and said-Butchery. There’s privacy only when it suits the medical facility, but not to protect the patient. At least it seems that way to me.

        • JR DNR

          Link that Describes it in detail:

          https://www.health.ny.gov/diseases/chronic/reflex_sympathetic/

          “Continuous, intense pain that is out of proportion to the severity of the injury (if an injury occurred) and which gets worse rather than better over time.”

  • Ladyimacbeth

    Yep. I fear unencrypted laptops, putting PHI in clouds, flash drives, etc much more than I fear anything with a paper record. You know those files on flash drives are not being deleted properly, and flash drives get lost. I don’t want my PHI on a flash drive. Wonder if I can request that the next time I’m seen? It’s frightening.

  • JW

    Possibly some patients might wait a while before getting to depression, but please be careful not to jump to conclusions. If they tell you it’s not from depression, they probably have something else going on. If doctors want patients to tell the truth, doctors have to listen to patients when they tell the truth.

    Something described as “fatigue” can come from incidental depression or depressive diseases, but something described that way can also come from rheumatic diseases, neurological diseases, ME/CFS (which has immunological features and probably neurological features and may be autoimmune, and has a prevalence of approximately 0.42 [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021257/; http://www.ncbi.nlm.nih.gov/pubmed/24343819 ; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616604/; http://www.ncbi.nlm.nih.gov/pubmed/22039471; http://mecfs.stanford.edu/documents/2014StanfordME_CFSSymposiumBrochurefinal.pdf; more conference links on 3/29/2014 post here http://www.iacfsme.org/ ; http://www.investinme.eu/Documents/Leaflet%202014.pdf ]), dysautonomia, vitamin D deficiency, and Ehlers-Danlos syndrome, just to name a few.

    Some of these could contribute to loss of job. So no, I don’t think it helps with differential diagnosis. It could help with documenting the patient’s real difficulties with work so they can get social support (including medical insurance–right now a successful disability claim is the ONLY mainstream avenue for health insurance for people who cannot work, as there is a minimum income requirement for access to the exchanges and to Medicaid without Medicare) if necessary, however.

    Diseases of depression and anxiety are important diseases and deserve to be diagnosed just as carefully and the patients treated just as respectfully as those with Lupus, etc. As JR DNR said, these and fatigue are likely a sign of underlying illness, even if not currently diagnosable as such.

  • http://www.idealmedicalcare.org PamelaWibleMD

    You are SO right on with this. I have ALL my medical records on ONE SD card (with a back-up SD card stored in another location). All charts are password protected. My IT guy tells me I have the most secure records in the country. Nobody can access except me—solo doc, no staff.