I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know. When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like LAB, ER, ...

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It is all too common for a section in a progress note to look something like this:

# Aspiration pneumonia:
  1. Continue vancomycin 1 g bid
  2. Continue Zosyn 3.325 g q6h
  3. Follow-up blood cultures
  4. Follow-up sputum cultures
  5. MRSA nares screen negative
  6. Blood cultures negative
  7. Discontinue vancomycin
Yesterday, a version of this note (lines 1 to 5 to be precise) had my name on it. Today, it is signed by someone else. Read it ...

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At the start of the transition to electronic health records (EHRs), I was totally on board as one would expect of a millennial doctor. I, along with my fellow millennials, grew up alongside the internet. We can type with our eyes closed, navigate pop-ups in a jiffy and intuitively know how to manipulate electronic charts to serve our purposes. But, I did find myself in a unique position in the millennial ...

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Historically, the doctor-patient relationship has been at the heart of medical practice, with administrative tasks and record-keeping at the border. Today, that critical balance is at risk. Nearly all hospitals and 80 percent of medical practices use electronic health records (EHRs), presumably to help improve access to health information and increase productivity. The problem is that none of these digital tools were designed specifically to advance the practice of good medicine. Consider ...

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I do some of my best thinking while exercising. A few years ago, I was swimming laps in the still-dark early morning. Swimming is one of my favorite activities. But in a pool, it gets boring staring at the bottom, so my mind often wanders off to tackle difficult problems. That morning, like many of you, I was wrestling with the question of how to turn my passion into a successful side gig ...

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The third year of medical school is when a student experiences the frustrations of medicine firsthand. Once, my team admitted a transfer patient from another hospital to treat a condition that was ravaging the patient’s lungs. But before we could act, we needed to rule out a dormant infection; if our patient was unknowingly infected with tuberculosis (TB), giving our first-line therapies could lead to a disseminated infection — even ...

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Some doctors choose medicine because of the medicine, and some doctors choose medicine because of the people. I veer towards the latter: Medicine is my tool to help the person sitting across from me. However, I am finding more and more stuff getting in between me and my patients, primarily my computer. The increasing burden of gathering coded health data in the EMR, especially in light of the impending MACRA, MIPS ...

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The frontlines of health care have been transformed over the last decade as electronic medical records have been rolled out across America. Unfortunately, information technology has yet to live up to its immense promise in health care­ -- a topic that I frequently write about. As somebody who has worked with every single major EHR on my travels, I am being brutally honest when I say not a single one ...

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Last week I made a patient's chart perfect. Not bragging, but ultimately it ended up being pretty easy, and I'll explain how and why in a little bit. This was a patient I had not seen in several years, with a number of chronic medical problems, for which he had been taking less than optimal care of himself since I had seen him last. Here for a "checkup," we talked about his health ...

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Four and a half years ago I read an editorial in JAMA, the Journal of the American Medical Association, that etched a short phrase into my memory. These five words seemed so profound and poignant that I really think they almost define primary care medicine today, perhaps with the alliterative addition of the word “teach”. Dr. Abigail Zuger wrote of how the computer had changed the dynamic in the ...

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