Seeing Through

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“Remember, that meeting is at noon today,” the IM from my office manager read. 

“Meeting?” I typed back. I flipped to my Outlook calendar. 

It wasn’t there.

Damn.

“Yes, THE meeting…,” the window popped up on my screen again.

The patient on the exam table was telling me a long story about the death of his childhood dog. I nodded and made a sympathetic sound as he got to the really sad part. I had heard it a few times before…

“The one where they don’t want us to be working on our computers, the one where we are supposed to provide our undivided attention?” There were fifty-two items on my EHR’s virtual desktop right now with a full schedule the rest of the morning and a lunch appointment with a friend.

A bright spot appeared suddenly in my field of vision. Like I had stared at the sun for far too long. But it was not going away, the sun was not visible, and I had not been around any flash bulbs or used the ophthalmoscope on the wall.

I blinked a few times.

Still there. I sighed. 

Not again.

“That’s the one. And have you RSVP’d for the Saturday meeting?” he responded.

“I’m not going.”

“You know that it is strongly encouraged and if you don’t go you have to email an adequate excuse to the system president.”

The scintillating pattern started to develop further and wind its way across my field of vision. It was a struggle to type without errors.

“I am not going.” I typed again and hit send.

“Are you serious?” he responded. I shifted my eyes around and moved my head a bit to see his words around the growing hole in my vision.

“Yes,” I typed back then realized the patient was quiet, waiting expectantly. 

Story over.

I thanked the gentleman for telling me the story and quickly entered orders on his chart in case the ocular migraine was going to get worse before it got better. 

An IM flashed from the front desk flashed up to say that my 9:30 patient was 20 minutes late for their physical exam appointment and could I still see them? The rule is 15 minutes late you reschedule unless there are extenuating circumstances. They shouldn’t even be asking.

“Please have them reschedule.” I was already running behind because my 8AM had arrived ten minutes late.

“I see you are needing a tetanus booster. Can I give that to you today?”

He nodded.

I sent an IM to my medical assistant to alert her to give him the immunization.

Once that was addressed I did a quick exam. 

Luckily, you don’t have to see well to be able to listen to someone’s heart and lungs.

“We are going to change your blood pressure medication, increasing the dose. Schedule a follow up for one month but if you can call me with some home blood pressure readings in a week or two I can adjust the meds further if needed and get this controlled faster, saving you an extra visit down the road. Got it?”

“Sure thing, Doc!” He grinned.

I almost missed his hand when he reached out to shake mine, then I dashed out of the room.

My office manager was standing outside at the nurses’ station waiting for me, arms folded across his chest.

“They rescheduled the meeting to next week.”

“What?!?!??!”

“So mark your calendar right now…”

It isn’t enough that I touch an average of 110-170 documents in the electronic health record per day. Or that I get from 20-50 emails per day (half of those are about various EHR systems that are not working properly that day or about our numbers for this measure or that measure). Or that I address countless IMs from various staff members throughout the day. I have the attention span of a flea nowadays and THEY made me this way. Now I have sit through hours and hours of meetings “paying attention”to stuff I really don’t care about anyway? I am not sure I can do that without being medicated.

I really, really don’t want to do that.

If brains on video games are remodeled, what happens to brains on EHRs, I wonder?

Is all of this why my ocular migraines are back?

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85 thoughts on “Seeing Through

  1. When I read blogs like these, I sometimes think that training in medicine in the developing world actually gave me a lot more chance of actually being with the patient instead of interfacing with a computer all day.

    Also, hope you feel better and do not have migraine attacks any time soon.

    Liked by 3 people

    • Thank you! I would like for these computer systems to just disappear. Poof! They used to be helpful. Now they are massive behemoths that are dangerous and detract from the most important reason we are doing what we do… The patient.

      Liked by 4 people

  2. I’m impressed you have an Outlook calendar. I just have hastily scratched notes on the back of envelopes I have no intention of ever looking at again.

    My sympathies on the paperwork woes, er actually the digital red tape nightmare that has become our lives. My only joy in life these days is defiantly filling things out in pink pen and pretending to not understand the questions. 🙂

    Liked by 2 people

  3. Oh dear. I get migraines and can’t interact–can’t talk when I have them. Luckily rarely.

    Just yesterday I read about this physician who does health-care oriented raps. ZDOGMD. He is brilliant. A real physician with a musical bent. And I wanted to tell you about him. So the timing was perfect — here is his rap on the horrors of EHR:

    Liked by 6 people

  4. I agree it’s the multitasking. Also, there’s something …disorienting or confusing, I can’t think of the right word, about shifting our focus from screen to text to phone screen to person over and over again. It stresses ME out and I’m just a writer mom on the sofa.

    Liked by 1 person

  5. Ocular migraines are the worst. I don’t get them often any more, but when I do I have about 30 seconds to stop what I’m doing and lie down, or I pass out. Not fun when you’re rushing between appointments on a freeway, or trying to meet a crucial deadline! I’m usually out for just a minute or two, but when I come round I’m totally out of it and can’t stop crying.

    Yup, thinking about it, some of the lifestyle changes I’ve made have been good. Not especially profitable, but there are other issues.

    Liked by 1 person

  6. I get stressed just reading about your stress! I can’t imagine living it. Take care of yourself, however you can, even if you have to sneak it in for a few minutes here and there. The migraines are telling you something…listen.

    Liked by 3 people

  7. What caught my attention was the comment about that your attention span was like a flea. It seems that we’ve lost the ability to focus. No one wants to wait. No one wants to have to concentrate for more than a few minutes. Sad really. Even when talking to friends I wonder if part of us is saying hurry up and get to the heart of it. We need to unplug and focus everyday

    Liked by 1 person

  8. Yep, physicians are stressed over the EMR. Just had an annual physical and think it was more like a 3 minute exam and 20 minutes at the computer. Doc runs late on every appointment! Great video! (laughing) how many clicks for Ambien? Really? Seems almost true! Take care of yourself, Victo! Don’t think twice about scheduling a day off or a vacation ! 💛 Elizabeth

    Liked by 1 person

  9. I think you have it worse than anything that I had at VA. I think your job is slowly going to kill you if you don’t burn out first. You need a decent assistant but then NPs and PAs that are really good are extremely difficult to find. They often get “the God complex like some MDs do. The hearth care profession has made great strides but it’s in the dumps in many other ways.

    Liked by 1 person

  10. It is hard to know what to say Victo. i’m used to offering suggestions or comments. NeIther works here. I did work for a large retailer who had a custom enterprise system. It was terrible as well and everyone just gritted their teeth and did what they could . Eventually the owners came to realize that this inefficient system was costing them millions in lost productivity and it was continuing to do so. They did a revamp that also cost millions but seriously improved the system. About that time I was drafted as an IT business analyst and helped write a large program to further increase the efficiency. (I wrote the product spec – the screens the user sees that are used to set code). It was the most frustrating annoying job I ever did – and the results were amazing. We polled a test group of store owners and receivers on how they wanted the program to work. Then at each development stage we had them come to H.O. and ran what we had in test and took suggestions and even allowed them to play with the program itself in test.We did that about 5 times at various stages. It took a team of 12 IT folks over a year to build the program and when we rolled it out to the stores, it went so smooth that training necessary was minimal. In the end the program cost about 1.5 million to build and roll out and saved 2-3 million per year (increasing year over year) in productivity. Plus it made many folks happy.

    My point being that the owners have to be the ones to change your system, otherwise there is no hope. The migraines are likely due to stress as you pointed out. You know your situation better than anyone else, but let me remind you of something you already know. You are getting a warning shot across the bow. Fix it before it kills you. I had colon cancer in my 40’s and as such I am a participant in a large non-profit Canadian organization that collects info on colon cancer patients to try and find common attributes. There is one. And it is stress. Over 75% of participants (those who had colon cancer) reported that they had suffered a period of unusually high stress in their lives the year before being diagnosed with cancer. As far as causative factors is concerned, that is about as definitive as we’ll get.

    Take care of yourself Victo. We don’t want to lose you. 🙂

    Liked by 1 person

    • We are changing EHRs in October, another source of stress. It will require 18 hrs of training just for me. Front office staff, 8hrs. Back office staff, 8hrs. If I want the cross train my staff then they have to do 16 hrs for front and back office training. So I was thinking last night what is really crucial for an electronic health record? Why does it have to be so complex? Really, you just need a way to follow preventive health, enter/prescribe meds, record notes, receive results, address calls from patients, and receive consult notes. Everything else is distracting fluff.

      Liked by 2 people

  11. Really, REALLY sorry to hear your migraines are back. When my own were at their worst, back in my 20s, I’d get severely compromised sight in one eye, too. Which is not only frightening, it’s also super disorienting — especially as the rest of the world carries on around you, business as usual. You have all my empathy!

    Those migraines were work-stress-related too, come to think of it. You’d think the places that stand to benefit from an individual’s health and productivity would cultivate that productivity like their bottom line depended on it! Or…not. :/

    Liked by 1 person

    • I have started to become militant about who sends me crap to deal with. The system has employed people to send me notes saying, “you scheduled this patient for his diabetes follow up, he will need X,y,z done.” I am not stupid or lazy or a bad physician. I address all of this at each appointment and my numbers reflect this. I don’t need notes in the EHR to remind me that I have to read, touch, and delete. I am going to get labeled a bitch but I don’t care… 😉

      Liked by 1 person

  12. OHHHHh do I feel your pain. We just found out we have a completely new medication profile to roll out to all clinical staff. They sent the notify last month, but the training is still in Beta. It goes live, LIVE… June 1st. We got an extension until June 18th. They gave us the draft training and said they would update it as it periodically. REALLY??? “Ok nurses, we are going to reconcile meds today this way but next week, you need to click here to show you did it and by the way, click here to sign off that you reviewed it on this date and then updated here on this date…no wait, we think it is better you do it this way……… argggghhhh
    I hope your migraine is better. That’s scary shit. I highly recommend a day for just you and the kiddos, prn!

    Liked by 1 person

  13. Your posts fascinate me. I read a couple to my son who is in college in Emergency Medical Care. He’s always wanted to be a firefighter but lately has been considering becoming a PA. His girlfriend is in the same EMC program as my son but plans to go on to medical school. My son just said, that’s why I should stick to firefighting and have a rotating schedule with lots of time off. I can be a stay at home dad. Guess we’ll see. He and I both were intrigued and saddened about your rat post. That must have been awful for you and the rats. My PA friend talks about breaking the necks of hamsters in her research. Well, I guess I’m glad I became a school guidance counselor and now writer. I almost went back to school to become a nurse or PA but you’re really educating lots of folks about how unselfish and bush your life is and we may look at our docs with more respect. Good luck and thanks for this insight.

    Liked by 1 person

  14. Doc, take care of yourself! Don’t let emails or paper work out you on need rest. Of you feel overwhelmed, take a break or adj for help. It’s okay to be human and to let a orient our coworker know that you need to take 10. You can’t help anybody Brigitte you help u yourself. I know. You break down and then everything stops. Go easy on yourself, you’re not a robot. Please, doc😦

    Liked by 1 person

  15. I have read your blog for a long time…commented not too many times. With all due respect I have to say I am glad you are not my doctor. This is not fair to the patient…and I do believe they do know. Take the same advice you would give a patient….get out! Life is too short….if not now…when?

    Liked by 1 person

    • The problem has become how do you manage the information in a way that is healthy, respectful, and effective. I agree that it is disruptive. Whether or not the patient is aware is a mute point. It affects the quality of care and is not fair to the patient at all. Unfortunately, this is going on behind the scenes in every practice that utilizes an EHR. That is an explanation, not an excuse. I write about it honestly so people know. It is a problem that needs to change. I fought the requirement to have the IM installed on my computer for this very reason. More info and communication does not translate into better care. Of course that labels me as a dinosaur curmudgeon now. Meh. Thanks for commenting!

      Like

  16. Another funny account of the pressures on professionals.
    One tip I have found useful in time management: Make – and block – appointments with yourself.
    No kidding. This will give you air. And let no-one cancel those appointments. Especially Dr Victoire, she’s likely to be the first to cancel them? And once you have your meeting with yourself, Work with yourself. Review all the things you haven’t had time to do. Clean up your desk. And look out your window: you can see the Louvre…
    (I know exactly which window that is. I think)
    Have a nice week-end, my friend.

    Liked by 1 person

  17. I’m surprised you haven’t walked out yet! How do you do it? I have ocular migraines from time to time – they used to be a harbinger of a real headbanger but now they just come and slowly go.

    Liked by 1 person

    • You know the analogy about throwing a frog into a pot of boiling water… He leaps out. But if you turn up the temp gradually, it cooks him by surprise. Small things that build until one day you realize your ass is cooked. That day I wrote about has been a turning point. I have shut off my computer IM entirely. I got pulled from the exam room twice today but they knocked on the door and got me rather than sending me a computer message. And of course I did not have all of the other minutia popping up all the time. It was very, very nice. I may get my hand slapped but frankly, I just don’t care. 🙂

      Like

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