Just sign here.
How many times a day are we asked to do this? “Just sign here.” “Just put down your license number.” “We need a stamp with your doctor’s info on it.” “Give us your NPI.” “Initial here, here, and here.”
If we took the time to read all the things we’re signing, we wouldn’t have time to do any doctoring.
The other day I was asked to hand-write the date on a prescription and then initial that I had dated the prescription, despite the fact that it already had the date stamped electronically as well as my own signature in ink.
I understand there are lots of regulations out there, things that have been put in place to prevent non-medical mischief, and we would all be fools if we thought fraud and waste wasn’t happening, if we all just went on faith that everyone in the healthcare system was really only looking out for the best for our patients.
The very concept that me signing something somehow makes it valid tells me we’ve created a system that is really just making sure that in case someone gets audited, that someone has a piece of paper that says Dr. Pelzman said it was okay to do what they did.
There’s my patient who sees a subspecialist every month, but every time the patient and his family present this doctor with paperwork for home care and medical supplies related to the underlying condition they are caring for, they say, “You really need an appointment with your primary care provider.”
Paperwork. About the only time subspecialists are anxious to get patients into primary care.
For that patient, for whom we’re providing no ongoing care given their advanced debilitating condition, we would be happy to engage in their care. But right now they just show up in our practice to get home care forms completed in the hope that by signing pieces of paper and faxing them back to durable medical equipment companies, that will get them the supplies they need to safely be cared for at home.
Are our signatures magical? Once you are a subspecialist, is it that you cannot be bothered with this kind of work?
I’m definitely not opposed to these patients getting the care they need nor the supplies they need, nor should the patient and their family have to go through all this nonsense simply to get what’s best for them.
As long as we’re rebuilding the system to make it more patient-centered, and to make it easier for us to get patients the care they need, while simultaneously improving the lives of those trying to deliver this care, maybe we can scrap all this paperwork.
Put the patient at the center, and let everyone working with them agree what needs to be done. Build this functionality into an electronic system, let the orders flow into our electronic health record and quickly flow out.
Who got to decide that in a state where paper prescriptions for medications are illegal that electronic prescriptions for durable medical equipment are illegal?
How come I can quickly and easily electronically prescribe every medication under the sun, but to give someone incontinence supplies, urinary catheters, wheelchair repair, or wound care supplies, I have to dig out my prescription paper, print a hard copy, then hand-write on the ICD-10 code and fax this off to the equipment supplier?
I want my patient to get physical therapy — I suggested it; I put in a referral to a physical therapist — but once they decided what they wanted the patient to do, why do they need to send them back to me so I can sign a piece of paper that says I think it’s okay that they get the things done that I thought I wanted them to do?
Why, when I send my diabetic patient to podiatrist, do they need to send a piece of paper to me that says I’m treating the patient for their diabetes and that they can give them diabetic care and diabetic footwear?
If I evaluate my patient and detect a hearing deficit, and I then refer them to an audiologist, who does the testing they do and determines that this patient needs hearing aids, why should they need to send me a piece of paper to sign that says I say it’s okay for them to have a hearing aid?
We’ve built up too many regulations, and we’ve allowed too many people who don’t know how to take care of people to get in the way of taking care of people.
I’m sure somewhere there are a bunch of regulations that were written with good intent, but too many people have misinterpreted them, used them to their advantage, and twisted them to try and make their own lives easier, when all this does is interfere with the care we’re trying to give our patients.
I really don’t think that even the federal government really needs me to hand-write today’s date on electronic prescription that has the date printed on it by the computer, and then initial that I dated the dated prescription. We’re drowning in a sea of paperwork, and we’ve gotten to the point where all we want to do is just sign on the dotted line.
We need to change the system to create a place where we can take care of our patients, where fraud cannot flourish, but so many of these rules and regulations need to be peeled back, to fall away, to free us up to be able to once again deliver truly patient-centered care.
Show me where to sign.
Fred N. Pelzman is an associate professor of medicine, New York Presbyterian Hospital and associate director, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs at MedPage Today’s Building the Patient-Centered Medical Home.
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