How can we possibly get to standardization in medicine? And is that a good thing? Standardized checklists save lives; rigid procedures for sterilization of equipment saves lives; universal compliance with recommended beneficial treatments saves lives. And while it's sometimes a wonderful thing to let a surgeon solve a problem creatively or to allow a patient visit to go overtime in order ...

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At a certain point, we've all got to go home. Whether it's the end of the shift when the factory whistle blows and the assembly line stops rolling for a brief period while new people take our place, or late in the day after the last patient has been seen and our notes are all written and our portal messages have ...

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Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to. One of the pieces of mail was an unsolicited package with a bright red label on it, along with ...

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As many of you know, if you've read my columns regularly, once a year the whole family escapes from the city, and we travel up to New Hampshire to stay at the lake house that's been in my wife's family for over 100 years. A modest wooden house perched out over the water, situated just right for sunset viewing, for a few ...

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During one long ago very hot Washington, DC summer, at the suggestion of my parents, I enrolled in a typing course that was given at our elementary school. This was the summer between sixth and seventh grades, and there were lots of things I would've preferred to have been doing, but my dad, who started out in advertising, felt that touch-typing ...

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About once or twice a day, everyone on our hospital's computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning. They include things like a notification that a particular data system is down and that a backup on paper will have to be used for documentation, or the hospital ...

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Collaboration is the key. When I think about how hard it is to take care of our patients, and how many different people are involved in their care, it's a wonder that anything ever gets done. We need to simplify systems, and harness the power of the information systems available to us, as well as the promise of the electronic medical record, ...

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As we've seen, the lives of those working in the health care system has become overwhelmingly challenging, burdened by all of the excess nonmedical stuff that has been added into our lives as we try to take care of patients. From prior authorizations, to clicking in the electronic medical record, to endless streams of regulatory requirements, to the continuous onslaught created by ...

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It's always kind of a surprise when you read a patient's chart, and you see an examination of a body part they just don't have. Just the other day, I was reading a consult note on a patient of mine who had been seen by a subspecialist for evaluation of a serious issue, and I received back a long detailed office ...

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I just did my first telemedicine video visit. The concept seems so strange, the idea of carrying out an "office visit" without the patient actually being in the office. Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), ...

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Every year, there's this rite of passage, the passing of the baton, as our graduating senior residents move on to fellowships, or into spots as hospitalists, or to practice jobs here in New York City or other cities, and a fresh new group of newly-minted physicians arrives ready to take up the gauntlet of training as Internal Medicine doctors under our ...

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So, who doesn't want a better health care system? We are barraged with stories in the medical literature and in the public press about the terrible state of our health care system, what poor outcomes we have, the inefficiencies in care, complaints about the electronic medical record, inflated costs, lives ruined by medical bankruptcy, and massive social inequities in terms of access ...

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Falling through the cracks, when it comes to health care, is a bad thing, but the way things are going, it's getting harder and harder to avoid. Providers in every setting are bombarded on all sides with data, results, messages, and things crying out -- screaming -- for our attention. Take, for instance, the conundrum that appears when a patient is ...

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Yesterday, I got just about the strangest version of "MD aware" I have ever had. We all know what this is, the person who is relaying some critical clinical information (positive blood cultures, Mr. Smith in Room 402 is having chest pain, etc.), and then they ask for your name so they can write it down somewhere in the chart. In this case, ...

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From the sublime to the ridiculous. That's sort of how my day went yesterday. It started out with an early morning meeting with a colleague who has been implementing a telehealth program at one of our institution's practices, learning about how they have been using this technology, some of the bumps in the road they'd hit, and how they'd been able to ...

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Yesterday, I went into an exam room to print out some orders for a patient who needed to get his labs done at an outside facility. Due to his insurance, he cannot get his labs drawn in our office during a scheduled appointment, but must do it at one of the laboratories that his insurer has contracted with. Not a terribly big ...

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Several weeks ago, as I was walking through the halls of our hospital, out from an intersecting hallway drove a robotic delivery cart. Unmanned and adorned with sensors so it could tell where it was in the world, it motored along on its way, heading somewhere with a bunch of flashing lights and audible warning signals. I was told this was part ...

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Recently, I was called to task -- and probably rightly so -- for signing something I know I didn't read. This was several months ago, when one of my partners was out on family medical leave, and we divided up all of the coverage of her patients while she was away, making sure that forms for home health aides were signed so ...

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One little thing. Somehow, with the changeover to the latest release of our electronic medical record, something happened to some of the demographic information on our patients. Suddenly, an enormous number of patients were now labeled as choosing not to disclose their gender. When I first noticed this, it was flagged in bright yellow on the banner in a patient's chart when I ...

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Who works for who? How did we allow ourselves to let a system get built up around us that makes it so hard for us to take care of our patients? Our job is to advocate for our patients, to help guide them towards their best health, to help them understand the difficult choices and to live healthy lifestyles, to give them ...

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