Back in 2016, my hospital, also my employer, changed the EMR. I was fully integrated into another EMR, so changing was not on my to-do list in the later part of my career as a diabetologist. As you would expect, the transition was a nightmare and took me to a new low in my life. Crying in my wine became my new norm. I became distraught, felt imprisoned, and felt that ...

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I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, "I hate civilian medicine." I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. ...

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Just imagine the following: your assistant invites in Ms. Nichols, who has a migraine, a bad cough, and feels nauseated. You sit down, start talking about the symptoms, see her throat, measure her temperature, pulse rate, inquire more about the headache. In the end, you set up a diagnosis, you write a prescription for some meds, send the patient for some further exams due to the migraine, but ensure her ...

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“It should be in my chart.” I’m sure we have all heard this statement uttered with a subtle (or not so subtle) edge of frustration from our patients after asking a question such as “what medications do you take?”  I find clinicians despise this comment because it is interpreted as (a) the patient is not making an attempt to recall his or her medical history, or (b) that the patient doesn’t ...

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In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse ...

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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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A featured article titled "Death by A Thousand Clicks" addressed some of the serious problems and challenges we still face in the "digitization" of health care. As an early adopter of EHR since 2003 and a self-avowed "techie," I can vouch for the fact that many of the government initiatives in HIT, like "meaningful use," actually made many EHRs worse. Why? Because many of the regulations were being written by ...

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Anyone who has spent any time on the internet knows better than to spend much time on the comments from an opinion piece. The comments section, even one on a site as reputable and respected as the New York Times, is often a minefield of trolls, contrarians, and conspiracy theorists. But after reading “The American Medical System Is One Giant Workaround” by Theresa Brown, I couldn’t resist. Among ...

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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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Having been an improvement advisor with many quality improvement initiatives and collaboratives, I have observed that stories about successful initiatives too often leave out major relational barriers that got in the way as well as the critical interventions necessary to overcome them. That important details about relational challenges so often remain hidden is not a small problem. Evidence points to relational issues as a major cause of lack of expected success ...

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I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into ...

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In a world where, in a moment, I can order from thousands of items and have them delivered to my doorstep the same or next day at the press of a button without having to re-enter my name, address, and billing information each time, it would seem that filling out paper forms at the doctor’s office by hand to have someone else re-enter the information into a computer that doesn’t ...

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The use of health care information technology has increased exponentially over the last five years, and as a frontline physician, I have seen this change at close quarters. In most of the hospitals I’ve worked in up and down the East Coast, it’s been interesting to observe this transformation. The process has usually started with nurses and then moved on to encompass doctors. It’s overall a good thing, as I 
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Today was like no other day. It was our first day together. Me and my "virtual" scribe — an actual person who seems to "virtually" to exist inside of a Jabra speaker on my desk and so subtlety that I forgot to mute a few times when not seeing patients. The "man" in the Jabra speaker now knows just how long of an appointment I need for my hair, and that ...

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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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More than 200 health organizations have now implemented OpenNotes. Many more are piloting, are soon to implement — or have implemented, and we don’t know it! For more than three years I’ve been fortunate to represent OpenNotes to potential implementers, and I’m confident I’ve heard almost every clinician concern or anxiety regarding what might happen when patients read their own notes. Here are the five most common concerns I’ve heard — ...

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What if each new feature of your medical record came with a description of how it would improve patient value, not just how to use it? Could a simple checklist help to achieve Annals' vision of putting patients first by helping to ensure that health care innovators release only those features that help us improve patient value? Could a simple checklist help organizations reduce ...

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It's 10 p.m. Seven days before Christmas. I'm sitting at work "finishing" up some charts. I am suddenly overcome with anger. What am I doing here right now at this minute? I am helping no one. This work I'm typing away at — trying so hard not to scream — it's hoops. Fucki*g hoops ... for insurance companies. So I can beg them to pay me. Pay me pennies for the hard, good, compassionate, humanitarian ...

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Today's medicine is not the medicine I signed up for. I am a Xennial. Sandwiched between generation X and millennials, I don't really belong to either. I didn't grow up with the technological advancements that the millennial generation enjoy. I grew up with corded telephones, large box televisions, and without a computer in the house. We played in the streets until dark with the neighborhood kids and played board games ...

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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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