Hospital bylaws saved this doctor from EMR burnout

Physicians do not have a lot of power these days. But if you know when, where and how to look, we can, on occasion, score some victories.

Case in point: hospital bylaws that every physician is required to acknowledge and sign before being granted privileges. It is always a good idea to carefully read before signing anything, and I did the just that before signing my hospital’s bylaws. I asked a couple of attorney friends if the regulations were like a contract that both parties had to agree upon and although there was some disagreement the consensus was yes, that signing hospital bylaws, in fact, protected both parties from misbehavior by the other. I did not know it at the time, but this simple fact saved me several times from hijinx that my hospital administration tried to pull. It is a good example of what physicians can do to protect themselves if we were to only look and not just swallow what we are told.

It was the late 1990s when my hospital first tried to inflict upon its staff an EMR system. Being a fan of technology, I was ready to embrace the concept, but it became clear very quickly how unwieldy and cumbersome this would be. Still, I initially gave it a fair shot and attended the first two of what would have been six required sessions in training as to how to use the system. Halfway through the second session, I realized how unworkable the EMR would be, so I decided to bow out, politely saying that I would stick to the old pen and paper system for orders and notes. At that time, I was naive to think that the hospital would be willing to accept feedback from its staff and work with them but this was before I knew about meaningless use criteria and how the hospital would not get paid if not enough physicians were using the EMR.

So the pressure started. I first received notice that attending the instruction sessions were required for staff privileges. I turned to the bylaws that both I and the hospital signed and sure enough no where did it say that attending instruction meetings on EMR training was a requirement for privileges. I was then informed that the hospital was to to require all physicians to use EMR by a certain date or lose staff privileges. Once again, I reviewed the bylaws and no where did it say that using EMR was a requirement for staff privileges. I simply wrote back to administration and reminded them of these facts. At first, they tried threats but realized that they did not have a leg to stand on. My sources told me that there were some heated discussions between the CEO and the hospital attorneys. The hospitals next trick was to try and change the bylaws. My attorney friends said the hospital was well within its rights to change its bylaws, but a physician who was already on staff was under no obligation to follow the new ones. In fact, this is why the hospital must inform its staff that the bylaws have been changed. If the staff member does nothing, then its an indication of acceptance. However, if the staff member does not want to follow the new bylaws they can request grandfather status, so that is exactly what I did. My sources told me that when the CEO asked the hospital attorneys if I could request grandfather status and they said yes, the CEO threw a fit. My sources then told me that there would be an attempt to force physicians to use the EMR by eliminating all the paper order and progress notes sheets. I simply grabbed a stack of both, hid them and used them when needed. I even managed to get the nurses on my side who absolutely hated the new EMR but could not do anything about it because they were hospital employees. There was even a vain attempt to instruct the nurses to not accept my paper orders but when I informed administration that they were, countermanding a licensed physician’s orders they quickly backed down.

This battle was finally settled when more and more physicians took my stance and refused to use the EMR. I had stashed away enough paper progress notes and orders so that my allies could follow my lead. By the time of my retirement, I was still using paper and the hospital had gone through its fifth iteration of its EMR.

The moral of this story is that physicians do not have to be doormats. We do have the power to control our destinies if we know how, when and where to look and be willing to use the power we have. Certainly better than being at continual risk for burnout.

Thomas D. Guastavino is an orthopedic surgeon.

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