Why would an Emergency Room physician order a pregnancy test for a male patient? Why would any doctor do so?
Dennis Bethel, an ER Room (increasingly referred to as an ER Department) physician, has provided an answer, and it’s not a pretty one.
First, note this: Physicians are not, in general, huge fans of electronic health records, because EHR systems require that they record way more about their patient interactions than they traditionally have done – when record-keeping was a paper-based operation.
Physicians often feel that the increasingly stringent EHR rules, which require entering patient diagnoses and treatment details into a computer, are too time-consuming and, somehow, too ‘judging’ of their actions as health care practitioners. EHR also necessitate using a computer, something many physicians – particularly older ones – want little if anything to do with.
As one doctor put it, in a testimonial for a specific EHR system, she wants to be “looking up at the patient, not down at a computer screen.”
A few years ago, I quit a particular physician because she was so intent on hand-writing notes that she didn’t even bother to look up at me when I was making a complaint about and describing a pain in my leg. “Oh, that’s just arthritis,” she said, without a moment’s hesitation, or even the slightest glance in my direction.
Her diagnosis was wrong. I confirmed that shortly thereafter when a different doctor diagnosed my condition as having nothing to do with my leg, per se: “It’s a pinched nerve in your back,” he said, correctly.
Several epidural shots and months of physical therapy later, I still have some ‘back issues’, and the leg pain comes back from time to time, too.
But the physician who couldn’t be bothered to look up from her note-taking or truly consider what might be causing my pain – a woman who will only be dragged, kicking and screaming, into the EHR era . . . well, actually, she probably never will be.
But she represents a mindset that is far from untypical in the medical community: While many are quick to embrace new techniques and procedures, there are far too many with the ‘we’ve always done it this way’ mentality.
Every time you walk into a small-practice doctor’s office, a place where you are likely to see a large wall or two filled with folders holding patients’ files, you get a small glimpse of the amount of time and effort your typical primary care physician (PCP) has traditionally put into record-keeping – and a glance at the vast amounts of paper the medical community has traditionally consumed on patients’ behalfs.
Modern day medical offices don’t have, or are attempting to evolve away from, those paper files. That’s a good thing, because EHRs can serve as diagnostic tools and, among other things, as a defenses when a physician has been accused in court of a misdiagnosis leading to . . . an ongoing trauma or death.
But here’s the thing, as Dr. Bethel points out:
“In almost 20 years of practicing emergency medicine, I can’t think of a single good reason to order a pregnancy test on a man in the emergency department. And yet, my colleagues and I still do it — and fairly regularly at that.
“In my case, the devil is the electronic medical record.
“Now this may sound funny to you, and I know the nurses love to read me the riot act when I do it, but truthfully this is no laughing matter.
“As easy as it is to order a pregnancy test on a man, it is equally as easy to give potassium to someone with hyperkalemia [a too-high level of serum potassium]. And causing an iatrogenic life-threatening arrhythmia is nothing to snicker about.
“The practice of medicine has become terrifying, [as doctors increasingly know] that the flawed technology forced upon us in many ways works against us and against patient care. And since doctors are no longer in charge, there isn’t much we can do about it.
“In the golden age of medicine, one thing was sacrosanct, and that was the patient-physician relationship. Unfortunately, the EMRs were neither built by or for doctors or their patients.
“Nevertheless, after bureaucrats and powerful third-party payers’ hijacked medicine, [their] electronic medical records were thrust upon us. It didn’t matter that a patient-centric, highly intuitive, easy to use system had not yet been created. It didn’t matter that the current systems were nowhere close to being ready for prime time.
“They had been green-lighted by the powers that be, and if patients were harmed in the process, I guess they figured that was just acceptable collateral damage. What else can I conclude given that I never even once ordered a pregnancy test on a man during the years I utilized the paper chart?
“This article would become a book if I had to list all of the problems with the electronic medical record system. Instead, let me just explain the pregnancy test problem.”
(Here’s the critical part:)
“Our EMR has a rolling patient screen. Unfortunately, that screen jumps up or down one space every time a patient is registered or discharged in the E.R. With 90,000 to 100,000 patient visits a year that happens almost continuously.
“In a misfortune of timing, if you go to put orders on your patient at the same time a new patient is registered, or an old patient is discharged, the screen can jump up or down without you knowing. The consequence of this is that you would click on the patient above or below the one you intended.
“It happens instantaneously — quite stealth-like in fact. As it turns out, it is not so easy to hit a moving target, especially when you don’t see it move. Unfortunately, all the doctors I’ve spoken with have had problems with it too.
“We’ve asked for a remedy from the manufacturer but apparently they have been unable to fix many of the flaws within their system. …
“It’s no longer good enough to be an excellent clinician well versed in disease processes and treatment. Microbiology may have prepared you to deal with the various “bugs” that ravage patients. Unfortunately, it did nothing to prepare you for the “bugs” in the computer system that sit there like landmines putting your patients in harm’s way.
“Now don’t get me wrong, I am not a technophobe. I have seen technology do great things. I also have no doubt that a high quality, highly intuitive, efficient, and safe electronic medical record can be built. Unfortunately, I fear that until we restore the patient-physician status back to its rightful place and put patient care before the almighty dollar, we’ll be stuck with the crap we currently have.
“Make no mistake; this stuff is dangerous and patients are being harmed.
“Until then, despite my best efforts, I guess it is inevitable that I will continue to order pregnancy tests on men. I pray that nothing worse than that slips by me.”
As a person, as a patient, I am appalled at this so-obvious breakdown in the ‘care system’. There is NO excuse for it.
I’m breaking this post into two parts. The second part also looks at EHRs, from a slightly different perspective.
I encourage you to ask your friends, family and colleagues to check out what my two blogs – Food TradeTrends.com and YouSayWhat.info – do in the interest of providing information you might, otherwise, never become aware of. You never know: Some of my research could prove useful, or possibly amusing, to you (and them).