Well, it finally happened.
I became an MD 30 years ago, long before the EMR existed. This was also well before Dr. Google appeared on the scene. A time when medical records existed only on paper.
I remember getting frustrated when I had to see a patient without their paper chart, as it was still in another physician’s office. I was griped about not being able to find a particular piece of information, such as a lab report or consultation note, when all I had in my hands was volume 1, not volume 5.
I also recall the era when not everyone dictated their notes. Too often, I was frantically trying to decipher someone else’s handwriting before walking into my exam room to discuss important information with a patient.
I certainly don’t miss writing out all prescriptions by hand – especially for my patients who had 40 prescriptions and wanted two sets (one for a one-month supply at their local pharmacy and one for a yearly supply to send to their mail order pharmacy).
I was “on the team” when our large clinic first heralded EPIC, and I was an “at-the-elbow super user” helping my colleagues when they were learning how to navigate the new technology.
The initial vision for the EMR was perfect: have one place for all to communicate, document, and share patient care. It was a relief to have a medication list, a problem list, and test results. It was great to share, communicate, and collaborate with colleagues.
Fast forward to our current era.
The EMR is now an epic failure – pun intended!
Problem lists are typically incorrect, often obsolete, and basically just a coding tool for insurance reimbursement.
Medication lists are never current or completely accurate. Yes, never. Trust me, I know.
Communication is often degraded to templated notes that say nothing literally, except for a few lines of poor grammar that one has to first scroll through 10 pages just to find. Translate: one page paper notes are now 14-page electronic notes.
Garbage in, garbage out. I could go on and on.
But, the most shocking part is that the EMR is now actually harmful.
Like other human beings, physicians are patients too. And sometimes, we have complex medical concerns or a chronic illness that doesn’t fit neatly into one medical discipline.
We need care like everyone else for simple things such as a laceration, an ankle sprain, bronchitis, and so on. We also get treated for cancer, pain, autoimmune diseases, and so many other things that all patients can get.
What does this have to do with the EMR?
Well, imagine that you were referred to a specialist, and that there were already two other referrals in the system for the same specialty. It would appear that you were “doctor shopping” (an insulting term) when you actually had no idea that triplicate electronic referrals existed.
This particular specialty covers many different medical conditions, both acute and chronic. I have seen three different physicians in this specialty for specific medical conditions – a grand total of 4 office visits in 15 years – and was referred by my primary care physician each time.
Last month, I was confused by a brief and rather brisk voicemail on my phone regarding a specialty referral. The staff member stated, “please call our office as there are some issues regarding your referral.”
I was taking care of patients, so I didn’t get this message until after office hours. I logged into the EMR patient portal to see if I could glean any information.
I was shocked to see a lengthy, detailed note from this specialist whom I have never met.
In my record.
It was a note to her medical staff member regarding if I could be seen for a consultation in response to the electronic referrals.
The content of this specialty physician’s note was harmful – and that’s me being polite! It had numerous inaccurate statements about me and about my reason for potential consultation.
The physician had messaged her staff to set boundaries and conditions (six, to be precise), and she used capital letters for emphasis. If these conditions were met, then – and only then – would she see me for consultation.
But only for one visit.
Did this physician spend an hour in my EMR looking through documents? She must have had plenty of time on her hands because her note to her staff member was quite long.
And utterly false.
Now, for all to see, anyone who looks at my electronic record can read her note. A note written by a physician I have never met. Someone who knows nothing about me. Yet, she has “documented” harmful and incorrect assumptions about me.
I am still processing my anger.
My head is still reeling.
It took me a full week to regain my composure.
My primary care physician apologized no less than ten times, even though this had nothing to do with her. She completely agreed that this specialist’s documented note was callus, dismissive, uncaring, harmful, and insulting.
I am not “doctor shopping” and never have been.
I am not complicated, but I have complex medical concerns (as do 80 percent of my patients).
There really is no great analogy to this situation, but the closest one I can think of is being considered guilty until proven innocent.
To quote my PCP, “You deserve a care team that is engaged with compassionate curiosity and truly listens.”
Don’t we all?
Perhaps the only good that has come from this experience is that I am an even better advocate for my own patients and clients, and a stronger ally to my colleagues.
I always have been and always will be.
Susan J. Baumgaertel is an internal medicine physician.