Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Unintended consequences of standardizing physician practice

Steve Wilkins, MPH
Physician
September 22, 2011
306 Shares
Share
Tweet
Share

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine.  It is called de-skilling.  De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things.  Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P), patient centered medical home (PCMH) requirements and so on.

Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use.  EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.

Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior.  Most indicated  that valuable patient information was being lost given how physicians adapted to using the EMR.  Why?  The physicians believed that the EMR forced them to change how they “fed their clinical thought processes into a patient’s record.”

The majority of PCPs interviewed reported situations where they or specialists “cut and paste the same exact language and statements, sometimes consisting of entire narratives across different patient records” where patients had the same condition (usually a chronic condition):

The net result was that PCPs believed they were increasingly getting less patient-specific information from specialists via the EMR which hindered their ability to make informed decisions around diagnosis and treatment.

According to these same physicians, this situation did not happen with paper records.  That is because paper records forced clinicians to dictate a certain amount of unique verbiage for transcription into a patient’s record:

Time pressures also contribute to physician de-skilling relative to EMRs.  Most EMR systems use templates that physicians must modify for each patient.  Physicians in the study complained that there wasn’t enough time to edited the EMR templates and then enter the proper patient information.  The conclusion, according to researchers, was that “some of the docs just do the bare minimum in terms of putting stuff into the EMR. When you read what’s in the record you’re kind of like, what is this?’’

In other words, some physicians simply didn’t bother to tailor EMR templates to the needs of the patient choosing instead to simply get through the standardized template.

The bottom line is that physician de-skilling has serious implications for patient outcomes and quality of care.

Patients need to be aware of and protect themselves from instances of physician de-skilling.  How can patient do that? The best way is to ask your doctor to review the patient notes section of your electronic patient record to see what you doctor entered about your condition.  Is what your doctor entered accurate? Is it complete? Given that others providers will be relying on the quality of your record for treatment decisions, this is something that everyone, patient and physician, need to be aware of.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Doctors are the true consumers of health care dollars

September 21, 2011 Kevin 3
…
Next

Patients need help to navigate the health care system

September 22, 2011 Kevin 8
…

Tagged as: Primary Care, Public Health & Policy, Specialist

Post navigation

< Previous Post
Doctors are the true consumers of health care dollars
Next Post >
Patients need help to navigate the health care system

More by Steve Wilkins, MPH

  • a desk with keyboard and ipad with the kevinmd logo

    If you build a patient portal, why won’t they come?

    Steve Wilkins, MPH
  • a desk with keyboard and ipad with the kevinmd logo

    When patients are socialized into the sick role

    Steve Wilkins, MPH
  • a desk with keyboard and ipad with the kevinmd logo

    There is no app for patient engagement

    Steve Wilkins, MPH

More in Physician

  • America’s pain management nightmare: How the DEA shaped the opioid epidemic

    L. Joseph Parker, MD
  • The middleman dilemma in health care

    Anonymous
  • Why write? Physicians share their stories of healing through writing.

    Kim Downey, PT
  • A doctor struggles to provide mental health care in Appalachia

    Ryan McCarthy, MD
  • Physicians are burned out. Could entrepreneurship be a cure?

    Arun Mohan, MD, MBA
  • The dark role of science, medicine, and tasers

    L. Joseph Parker, MD
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • Coping with grief in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 24 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • ASCT Tops CAR T-Cell Therapy for Relapsed LBCL in Complete Remission
  • 'New Gold Standard' for Previously Untreated CLL
  • Emicizumab Safe, Effective, in Infants With Hemophilia A
  • Add-On Inavolisib Ups PFS in PIK3CA-Mutated Breast Cancer
  • Lovo-Cel 'Life-Changing, Transformative' in Sickle Cell Disease

Meeting Coverage

  • ASCT Tops CAR T-Cell Therapy for Relapsed LBCL in Complete Remission
  • 'New Gold Standard' for Previously Untreated CLL
  • Emicizumab Safe, Effective, in Infants With Hemophilia A
  • Add-On Inavolisib Ups PFS in PIK3CA-Mutated Breast Cancer
  • Lovo-Cel 'Life-Changing, Transformative' in Sickle Cell Disease
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • Coping with grief in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Unintended consequences of standardizing physician practice
24 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...