by SkepticalScalpel | Mar 15, 2016
An epidemic is sweeping the country, and no one is doing anything about it. No it’s not Zika virus. The epidemic I’m talking about is the widespread use of “copy and paste” in medical progress notes. How widespread is it? A 2009 study from Cornell surveyed faculty residents from two academic medical centers and found that 90% of the physicians who wrote inpatient notes electronically used copy and paste in their progress notes. Most of them acknowledged “that inconsistencies and outdated information were more common in notes containing copy and pasted text,” but fewer than 25% thought that using copy and paste was detrimental to documentation or caused errors in patient care. My anecdotal experience is that 90% is an underestimate. Using copy and paste can be detrimental. I have said before that it doesn’t matter what is written in a chart unless something goes wrong. “…90% of the physicians who wrote inpatient notes electronically used copy and paste in their progress notes” Progress notes in electronic records are cluttered enough without adding material that was in previous notes word for word. An even bigger problem is the extensive use of copy and paste raises issues of credibility. In a progress note, a patient was described as “alert and oriented X 3” because that’s what that the notes from the three previous days said. A few lines further down in the same note the physical examination said the patient was “intubated, sedated, and on mechanical ventilation.” Another note said, “The patient appears well nourished” because that appeared every day for the last week. Later on in the note,...
by SkepticalScalpel | Jul 1, 2013
In a post 2 weeks ago, I discussed why elderly patients don’t get out of bed and walk when hospitalized. You can read it here. I wrote that a major reason that staff does not have time to walk patients is that they are too busy documenting useless checkboxes on the electronic medical record. The New York Times article about the negative effects of bed rest on the elderly that led me to write the post stated that “hospital nurses seemed grateful” when the author offered to walk her father. She also mentioned that she had to supply a walker, robe, and slippers. My next question is: Could this be the first step toward third-world medicine? [Pun intended.] We’ve all heard stories about how in certain countries, families must provide hospitalized patients with bedding, food, and basic hygiene. A recent article about a family’s experiences with a relative who had surgery in Cuba illustrates the point. The author wrote, “Prior to the trip [to Cuba], my wife wisely purchased towels and two sets of sheets and pillowcases for her mother’s use during her hospital stay. In addition, we packed several aerosol cans of spray disinfectant, special soap used for sponge baths, and a room air-freshener that plugs into to an electrical outlet. Regarding the postoperative stay, he says, “The next 2 days for me was [sic] spent shuttling food and juice to the hospital for my wife and her mother.” “At the end of the third day, my mother-in-law had arranged to trade her used sheets and towels for a week’s supply of Vicodin and Percocet with another MD...
by Physicians Weekly | Jan 3, 2013
Several weeks ago, Primary Care Progress asked me to serve as one of their guest bloggers for this year’s National Primary Care Week, writing on the theme: “Why is primary care the future of healthcare?” I didn’t end up contributing a post, for a few reasons: 1) not enough time. 2) concern that the question was too physician-centric (rather than patient-centered). 3) the feeling that I had nothing new to say on the topic that I hadn’t already written before. Today, however, while teaching a group of first-year medical students about the Patient-Centered Medical Home and its potential to put primary care back in the center of the health system (in my opinion, exactly where it belongs), I had second thoughts. As the “Healthcare Headaches” blogger for U.S. News and World Report for 2010-11, I often wrote about the future of healthcare from my perspective as a family physician. Below I’ve assembled some links to — and excerpts from — posts that I think do a good job of describing why primary care is the future of healthcare. 1. Your Primary Care Team Will See You Now: The future of healthcare includes working in integrated teams, which will allow primary care physicians to meet current and future increased demand for medical services. In the primary care team model, the receptionist or a medical assistant could ask each patient to fill out a form with the necessary information. The medical assistant could then input this information into the tool and create a customized list of preventive recommendations. A medical assistant or nurse could then counsel patients about exercise habits, dietary practices, and smoking cessation before...
