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 — …
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 …
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 …
As Wei Wei Lee sat with her doctor to discuss starting a family, she felt a “distance” between them. The physician was busy on the computer and focused on the screen.
“It just didn’t feel very personal,” Lee said. “I didn’t feel heard.”
It seemed as though keeping a record of the conversation was more important to the doctor than making a connection with Lee.
It wasn’t the experience she wanted, but she …
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 …
Since the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, it has been said that health tech would dramatically revolutionize health care and the patient experience. Advocates have claimed time and time again that it would advance disease diagnosis capabilities, improve patient outcomes, and increase patient satisfaction. Belief in this narrative can be seen in the sharp increase in health tech investments, with …
Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way.
Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency department visit.
The notes from the emergency department providers, including a scribe and the …
With nearly 80 percent of internet users searching online for health-related information, it’s no wonder the catchphrase “Dr. Google” has caught on, to the delight of many searchers and the dismay of many real doctors.
What’s received little attention from physicians or the public is the company’s quiet …
A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance …
5,177.
That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket.
While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a notation every time a patient at our practice gets a flu shot, and also every time one of my patients or …
Burnout and dealing with its symptoms has become a hot topic in the last decade. It’s a problem that has multiple contributing factors. Some of those factors are thrust upon us and are beyond our control, such as government regulations. Other factors are self-imposed, and thus under our control, such as volunteering for extra call shifts. One self-imposed factor is a little thing we use to improve our lives, our …
We all have that one patient. That one patient who can always find a way to turn a good day bad, who just knows how to push your buttons in all the wrong ways.
Who’s that patient for me? Let’s just call him Elton Reed.
Oh, Mr. Reed … where to begin with him?
When we first met, I remember being so excited and energized by him. He just had this fresh feeling …
Fake news is a term that’s become notorious over the last couple of years. For notorious reasons perhaps. But there’s actually another serious arena where there is inadvertently an awful lot of “fake news” on a daily basis. And that is, well you guessed it: in health care throughout our nation’s hospitals and offices!
Let me explain, and I suspect anyone who works in health care will be familiar with the scenario. …
It is all too common for a section in a progress note to look something like this:
# Aspiration pneumonia:
- Continue vancomycin 1 g bid
- Continue Zosyn 3.325 g q6h
- Follow-up blood cultures
- Follow-up sputum cultures
- MRSA nares screen negative
- Blood cultures negative
- 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 …
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 …
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 …
In about 1990 we got our first computer. I say “we” because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers, and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001, I was communicating …
I find myself spending close to an hour on the computer each morning at the hospital. I spend this time dutifully looking up vital signs, labs, recent radiology or pathology results as well as many other valuable pieces of information about each of my patients. I watch as my colleagues frantically record values, while making sure to point out important trends and gross abnormalities.
When we round, there is always a …
To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.” We purposely keep our patients in pain, or we addict them to …
The business value of medication adherence tools is coming into focus. For years, I remarked that, while we could create a case for why adherence was the right thing to do, we had great difficulty creating the right financial incentives to move these programs from curiosity to scale. That is changing now with the collision in the marketplace of new payment models and exorbitantly priced pharmaceutical products.
The poster child for …
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