Click, click, click: How can I help you today?


Click, click, click, “Hello, how are you today?”

Click, click, click, “How long have you had a sore throat?”

Click, click, click, “Have you had a fever?”

Click, click, click, “Have a seat on my exam table, please.”

Click, click, click, welcome to my day.  Let me introduce myself, I’m a professional clicker.  I used to be a member of a highly respected and sought after profession; a doctor.  The modern world of government/insurer managed healthcare has turned me into an efficient clicker, busily documenting everything I do so that I can:

  • Be reimbursed for my services
  • Afford to pay my staff/landlord/utility/self
  • Avoid being prosecuted for fraud by Medicare
  • Avoid lawsuits
  • Communicate with other docs
  • Meet “quality” parameters set by Medicare/insurers

Being highly educated, my colleagues and I are easily trainable and have reached the pinnacle of “clicking.”  Now, Medicare and the New York Times are on the attack.  They are questioning if docs are “gaming” the system to receive higher pay.  They are questioning our ethics.

First of all, we did not create the system/game.  At every step of the way, we have been forced to play by Medicare’s and the insurers’ rules.  Not only have we been forced to play by their rules, we have also been forced to shoulder the expense of buying and learning to use the EMR (electronic medical record) that many of us did not want to use.

Second, the EMR made it easy to record what we never recorded in the past.  It’s hard to exam a person without examining his/her skin.  Acne and blemishes, skin color, texture and warmth are readily apparent.  In years past, only positive findings would have been recorded in my patient’s paper chart.  Now, click, click, click and it’s all recorded electronically.  In the old days, I knew what my notes meant.  Now, the rule is:  If it’s not recorded, you didn’t do it.

Click, click, click,  and everything I do is recorded.  Every click satisfies the rules Uncle Sam and the insurers of America have forced down our collective throats.  Does all the clicking improve medical care?  I think not.  Has all the clicking saved money?  Most definitely, it has not. Am I making more money?  Definitely not.  The upkeep and expenses associated with clicking is immense.

So, who profits?  No one.  If no one profits, why are we doing it?  We are clicking because we are being forced to click.  In 2014, we will be financially penalized for not clicking.  Now, we may be penalized for being too good at clicking.  The government is on a witch hunt looking for fraudulent clickers.  Sometimes, you can’t win.

One more question needs to be answered.  Clicks are data points and are being collected every minute of the day by Medicare and the insurers.  What’s being done with all that data?  That question is the one keeping me awake at night.

Click, click, click, “Good morning, how can I help you?”

Stewart Segal is a family physician who blogs at


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