Something Meaningful

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“Fifteen pages?!?! You can’t be serious?” I threw down the thick stack of pages. They slid off the counter onto the floor and scattered. I didn’t care. It felt good.

“You have to do it for Meaningful Use…” My office manager stared at me, frustration creeping into her voice.

“But a fifteen page patient visit summary? How is that going to be helpful for patients? What the hell could they possibly say that would require fifteen frickin’ pages after a fifteen minute office visit?!!!?” Rage. White, hot rage. I felt so much rage that I wanted to throw the damn computer against the wall. “And who the hell is going to ever wade through 15 pages of crap to find the important few bits?”

“Look, you have to get 50% of your patients using the online portal and this patient summary has to either be printed out for them or sent to the portal. You can document “declined” but if you do it on everyone, that will get you into trouble, too.” She was pleading.

The problem was that the online portal sucked. It was thrown together at the last minute and the interface on the physician side was awful. It was making my job so much harder and was confusing patients right and left. It was unreliable. Messages often weren’t getting sent.

“Ok. How’s this? I am not going to print it or send it to the portal or even document “declined”. I am going to continue printing out the two page summary that shows patients what I changed with their meds so when they drive over to the pharmacy they can make sure they are given everything that was prescribed. That handout has instructions and their preventive care recommendations and their vital signs. Everyone, but especially my elderly patients, need something concise in hand to take away with them. Since when did the government get to decide how I communicate with patients? This does not improve patient outcomes!”

They had also in one fell swoop taken away my ability to order immunizations in the EHR. My medical assistant had to now do that, so I could not print the superbill until after the immunizations were administered and documented. Completely disrupted work flow. Documentation of certain preventive care measures went from a single screen and two clicks to a multiple screen ten click ordeal. For each point. Worse, I could not document family medical history in my usual concise and organized manner: “Mother died age 45 due to heart disease, also had diabetes and hypertension”. I now had to use push buttons like “mother history of heart disease” and another button “mother history of hypertension” and another button “mother history of diabetes”. It was a difficult to read jumbled mess.

All because the government said so.

“You still have to play the game.” She shifted uncomfortably in her stiletto heels.

“Why?”

“You will get paid less for your Medicare patients.”

“I am not really paid much of anything at all anyway. How can I miss what I do not have?”

“They are following your data…,” she warned. Truthfully the powers that be here were following her data, too. If she couldn’t get her physicians to toe the line, the doctors who hired her to work at this clinic, she would be in trouble, too. I might have felt bad about that, but rage makes you blind to everyone but yourself. “AND, I am supposed to post this how-to instructional page here at your work space to remind you of what to do.”

I rolled my eyes.

“You know what you can do with that.”

“Yes, ma’am, I do.” She grinned at me, and tossed the how-to sheet into the waste bin as she walked away.

End of discussion.

I don’t know who exactly is responsible for this ridiculousness but you should be ashamed. All of you.

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92 thoughts on “Something Meaningful

  1. You have just described the start of my burnout with primary care. We need EMRs, no doubt, but the system needs a huge dose of improvement, especially in the area of meaningful use, as you point out. I’d often only get ten minutes for an acute appointment because we had so many patients wanting to be seen. And yet I’d spend at least another ten minutes on documentation. Is it any wonder I was there until 8 pm trying to finish my electronic charting? Oh boy, you’ve stressed me out all over again. πŸ˜‰

    Liked by 5 people

  2. No, not me! Don’t blame me! I am just a victim of socialist medicine, too. Thank God I don’t live in one of those countries that has Medicare. Duh! OK, so my latest is 333.1 and E9363. Sounds like Gabapentin, if I remember correctly. Let’s just move on. “NEXT!” “WHO’S NEXT?”

    Liked by 2 people

  3. It makes me mad! Not your story, but the governmental nonsense. It seems to be a world-wide thing. Recently I made an application and was asked: Who are your partner’s friend? Who are these friends’ friends? Have any of them ever taken drugs? I didn’t have a clue about any of the questions. I simply wanted to register my dog.

    Liked by 4 people

  4. We live in the era of middle men. There is money to be made by getting between workman and customer. It influences every aspect of business these days. The more confusing the middle man is, the more likely they can preserve the “indispensable” status they need to survive.

    Liked by 4 people

  5. Here in New Jersey doctors have to register and pay big bucks to join the vaccine registry. Without being registered, you can’t administer vaccines. I don’t think my husband is going to do it–we’ve given up flu shots quite a while ago because of poor reimbursement/being stuck with vials of vaccine that the drug company won’t take back. He still loves practicing medicine but we are looking into other practice models because we just can’t continue with volume medicine.

    Liked by 2 people

    • I do not pay to join the vaccine registry in my state (that I am aware of) and our supplier takes back our unused vaccines. At least they have in years past. The shingles vaccine, though. OMG. Don’t get me started on that.

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  6. Say it loudly, sister! The podiatrist I worked for and I had extremely different political views. 180 degrees. However… He had been in private practice for 35 years and decided it was time to quit when the idiotic paperwork requirements became too much. He grumbled about the politicians (ok, truthfully, he grumbled about the Dems, every single day, after watching FOX). But he was absolutely 100% correct on many of his assessmentsβ€”one being the days of a doctor being able to hang out a shingle and practice outside of a large, messy group are gone.

    I’m sort of studying ICD-9 and the once again postponed ICD-10. While I can see a little need for some expanded code, 10 takes to to a whole new level of absurd.

    I worked for Healthcare.gov/ACA/Obamacare. I’m so in favor of reform. The system is broken. What they gave us is a little bit of improvement. That has to be given to them. What they also gave us is a nightmare of idiotic, bureaucratic, nonsense that is detrimental and NOT a step in the right direction.

    15 pages? That’s not a report, that’s a novel.

    :::passes you some jammies and, if you like Scotch, a nice one otherwise choose your beverage of choice:::

    Liked by 1 person

  7. For the tragedy of all this (aside from the frustration you described) is the enormous amount of money wasted on all this administration and bureaucracy. Money wasted on developing these useless systems and money wasted on those to administer it. I often wonder if the widespread appeal of the post-apocalyptic narrative stems from the utter futility people feel while trapped like a hamster on a wheel in these systems.

    Liked by 4 people

    • Yes! What worries me the most is a selection towards physicians as sheep. Unthinking, silent, meek sheep who just do what they are told. That is not to say all change is bad. Change is awfully good at times. But we are starting to loose focus of the one thing this is all about: the patients!

      Liked by 2 people

      • I could have written the exact same response as you did here, exchanging the word “physicians” for teachers and “patients” for students. I feel your pain, just in a different theatre – it’s beyond frustrating. People think they are making good change but often don’t see the whole picture and/or are short-sighted.

        Liked by 1 person

      • Yes! Burying innovation under insurmountable mountains of rules and regulations and paperwork distracts and detracts from the primary focus. God bless teachers! You work even harder than me most days.

        Liked by 1 person

      • Yes, the primary focus is lost in service professions so often…teaching, medicine – and those of us who got into it to make a difference are thought of as sheep or automatons who should be able to adjust to any change, however inane without batting an eyelid. And forget about taking care of our own business …ha!

        Liked by 1 person

  8. There are obviously cases when/where the confluence of practicing medicine, technology and effective patient care has veered off-track. To your frustration, for what value-added purpose? In your profession, time with patients and quality care are critical. Is the system yielding its best?

    Liked by 1 person

  9. I couldn’t agree more Victo! You are venting the same exact exasperation I see in the many professionals I speak with every day in this industry. While reform is necessary, and there is nothing wrong with empowering patients to participate in their healthcare, it is virtually impossible when you are forced to cram 3 patients into a 15 minute window and still be expected to complete adequate paperwork, digital charting, coding, as well as meet multiple quality measures (to secure funding), and on and on it goes…That is why the message I have dedicated my life to conveying is one of freedom from this nonsense and a much more pleasant, less stressful, and patient-centered business model. It’s referred to as Direct Primary Care (DPC) or Concierge Medicine. I am working with a number of vendors and service providers to create a compendium of product/service reviews, and light consulting services to assist providers in making the leap. It’s time for providers to get back to practicing medicine, earning a good living doing so, enjoying their work, and not burning out in the process. If there is ever anything I can do, please feel free to reach out. (You are one of my favorites so I would even consider doing it for free!)

    Liked by 1 person

    • Not ready to do concierge medicine yet. I feel like it leaves out those who are financially strapped, who cannot afford large retainer fees. Thank you for your kind words, though. That means a lot! πŸ™‚

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      • Understandable, and it’s my pleasure of course. I will say I worked with a Physician in Texas who created his practice in such a way that his subscription model had three separate levels each for a different income group. You are able to offset the lower fees for the less fortunate by taking advantage of cash discounts on labs, supplies, radiology, and meds and utilizing telemedicine, group appointments, and home visits to maximize number of patients seen. There is always a way when, and if, you change your mind. Either way, I utterly enjoy reading your posts!

        Liked by 1 person

  10. Almost every clinic I go to used EMRs these days. Some are great to use – and very intuitive – and others are not. What I hate the most though, and it’s what my health region does, is in the hospital we have a provincial wide EMR but we still use paper charts for everything. Some stuff online, some stuff in charts… and different form one place to the next. Frustrating, to say the least! Either way, it sucks when people who know nothing about medicine and patient care come up with the “rules”

    Liked by 2 people

  11. a two page summary at the pharmacy would be a delightful thing to have. when i have a line of 15 people picking up meds i’m sure as heck not reading 15 pages just to figure out what the dazed faced looking patient needs to get (usually demands rather) to get ASAP… sounds like your office manager is a little too print happy.

    Liked by 1 person

  12. We looked at updating our EMR product last year. A crew of us looked through this new system which basically would make it possible for a monkey to chart in. Gone was any critical thinking for creating a care plan. It was all drop down and buttons. And you had to go from start to finish because if you answer on M2020 OASIS one way, it offered a new series of questions and on it went. They thought it would would help with quality. What it lacked was making time for the home visit working with the patient because you had to do ALL of the documentation in the home. We figures a normal 40 minute home visit would now be about two hours……. yeah, that saved money. I think that some jerk at CMS thinks up more ways to make it impossible for health care to make anyone healthy. “Its all about the billing…” (Sung to “Its all about the Bass”)

    Liked by 1 person

  13. One of my close coworkers does work for me but is also the meaningful use coordinator. Or meaningless use as our docs call it. As long as idiots in Congress are allowed to tell doctors how to work I don’t have much hope. You should see what meaningless use does to the operations people that have to build the reports and features the docs need. To be sure, there may be penalties (not yet) but for the first few years there are incentive payments. We’re trying to get the incentive money to pay for all these changes since we’re going to have to comply anyway.

    Liked by 1 person

  14. That’s insane. If this is for everyone, I guess I can expect to go home with a handful of papers for the boy to scribble on since both BG and I have appointments next week.

    Liked by 1 person

  15. I feel for you doctor, really I do. I’ve been there and done that while working for the VA system as a RN. More and more computer work involving patient care that we could barely deliver. Patients did not seem to matter anymore. The higher ups just wanted that d— paperless charting. it was redundant and meaningless. I’m retired now and I must say I have not once missed the place.

    We, who voted the dumb -dumb politicians into office are now paying the price for folks that have no clue what patient care is about. In my opinion all of the changes occur because flunkies have to justify that they are doing “their job.” Most of the folks making the changes have no idea what treating a patient entails.

    Just my humble opinion, doctor.

    Liked by 1 person

  16. Pingback: My Article Read (12-30-2014) | My Daily Musing

  17. Doc, your rage is mine. What I have just gone through with my Dad who was admitted Sunday with main complaint of coughing and shortness of breath, choking while eating, extreme weakness …. took the docs THREE days to figure out he has fluid on his lungs and just today, three days after being admited and subjected to every test known to man, aspirated his lung getting 800cc’s of fluid. I could have told them Sunday to take an x-ray and SEE the fluid in his lungs. This man is 90 years old, exhausted from being treated like a human rat, and finally after three days of torture, have given my Dad the right treatment. This is medicine? What happened to listening to the chief complaint and going from there? I live out of state, hopping mad, and yes as you know an ex ICU nurse and KNOW what is what. I sit here stunned, and knowing what torture my Dad has been through makes me want to throttle some necks. Sorry, Doc. I don’t understand why a chest x-ray was not taken so that right away that fluid could be aspirated. OMG. You talk about unnecessary paperwork … unnecessary testing, painful at that, is happening especially to elderly people. They have become guina pigs. Sorry for the rant. I would have exploded if I didn’t say something. Thank you, Doc.

    Liked by 2 people

      • *tears* Thank you. To feel this helpless when IF I had been there, I would have made sure docs heard me as to my thoughts regarding the situation. And family of course did not consult me either. Bless you for listening to me. I really needed YOU to hear me. Thank you.

        Liked by 1 person

    • I really do apologize for dumping on you yesterday. Sum it up to fatigue, stress, and major concern for my Dad. The good news today is the medicine he is now getting … antibiotics and steroids … he is already responding to. That and getting almost a liter of fluid off his lungs the man can now breathe easier. He has a long road ahead of him, but he looks like he is choosing to stay for a bit longer. No matter how much you prepare yourself, you are never ready to say goodbye to a Loved One. Bless you for not getting upset with me for dumping on you. You get enough of that at work. Love, Amy

      Liked by 1 person

  18. Hang in there Doctor, I’m coming to your rescue. Just five minutes ago I’ve started working on a bug. The bug multiplies faster than rabbits, and in its youth it only eats paper. If I’m successful, when it matures it will eat bureaucrats. (Well at least I’m trying. Lol.)

    Liked by 1 person

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