Embellished

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I used to be an author.

Every day I wrote two dozen or more short stories. 

Some were comedies:

“The pain in the right knee started after a snowboarding accident in Aspen two months ago during a spring break trip with friends. He swears that a tree suddenly jumped into his path and evasive maneuvers failed.”

Some were tragedies:

“The patient states that she learned last night that her husband has had a two year long affair with a coworker. She would like STD testing and something to help her sleep for a few days.”

Now I am supposed to point and click predetermined text to generate my note. It comes out something like this:

“The episode started two months ago. Pain is in the right knee. It is worse with movement. It is better with nothing.”

Where is the patient in that? Gone.

Then it is followed by a long list of smart text that generates an office note so full of crap that it is impossible to get to the meat of things quickly. I routinely get 4 page notes from specialists. I read the first paragraph and then the last page to hopefully figure out what is going on. The rest is meaningless drivel that is tacked on for billing purposes. I scan through hundreds of pages of documents every day. You know how I can read so many blog posts so quickly? Years of practice…

We are losing our humanity. 

Change the human body from a person to a machine.

Change the healthcare providers into automatons.

It is inevitable, isn’t it? Dehumanize the patient. Dehumanize the doctor. Dehumanize the nurses and medical assistants and other providers. Do it little bit by little bit. If you do it in one fell swoop, there will be rebellion. Whittle away at it in small bites so it is easy to swallow and then one day we will all look up in horror at what we have become but by then it will be too late.

Once you have done it to healthcare, do it to every other aspect of our lives. 

Little bit by little bit. 

I think, perhaps, it is already too late.

Homework assignment! Ask to read what your doctor writes about you next time you go in…. 

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97 thoughts on “Embellished

  1. It’s especially important to read them when they change systems (as they often do). Each time they change they get my medical history wrong.

    I review a lot of MedWatch — drug error — forms. There are coded sections and there is a narrative where you really learn a lot about what occurred. The narrative is what the reporter said, and it (often) keeps in the flavor. That seems like a good compromise for EHR systems. (Of course an EHR records much, much more).

    Liked by 1 person

    • I promise you there is no possible way for them to read all of your notes from every person in full detail. If one tells you that they are, run from them very fast because they cannot be trusted. That being said, they SHOULD be familiar with you, be current on all of your meds and if not, run away even faster.

      Liked by 1 person

  2. Asking questions of most docs now requires a hogtie and a headlock. If a pt gets more than 5-10 minutes before the NP comes in for the rest of the session it’s a minor miracle. The whole system is broken, and they wonder why people don’t visit their docs regularly. I’ve been in healthcare for 20 years now, and it’s regressing rather than improving. Costs skyrocket while good care plummets. Meds are scripted for EVERYTHING, but people can’t afford the price. And don’t even get me started on documentation, efficiency expect stations, suits who have little to no clinical experience making decisions for EVERYBODY. It’s a white-hot mess.

    Liked by 4 people

  3. Man.

    Nailed it.

    I do think there’s hope. I started reading some Chomsky and felt physically exhausted when I saw it was all about what’s broken.

    I’ve got a pretty solid sense of that already now. What I want to know now is how to fix it.

    This morning, I posted another “broken” post. I drove to work thinking how it’s time to start writing “fix” posts.

    I already have a half dozen in my head, helped along by a loverly article Rache sent me.

    (I could link it here, if you’d like!)

    Liked by 1 person

  4. Going to my GP tomorrow. I will ask. I hate what I see happening in medicine. I HATE it. And I deplore how we are being treated especially those of us over 50. It’s disgusting. I HATE the system that has turned us all I to parts and numbers. I LOVE medicine.

    Liked by 1 person

  5. This post was my first clue that perhaps it is different here in Canada.
    Yesterday I had an appointment with a shoulder specialist (yes, my shoulder issues are reaching soap opera status).
    After our discussion, he said he was going to dictate his notes because it was faster than writing or typing and asked me to interrupt if he got any of it wrong. He then proceeded to summarize our conversation and his observations into his phone.
    At least for that one appointment, I know exactly what was in his notes! 🙂

    Liked by 1 person

  6. It sounds like the election in the U.S. The voter is a statistic. The statistics show Hillary has an 82% chance of winning. Unfortunately, voters aren’t numbers and if the pundits and pollsters had left DC and New York and gotten out into the middle of the country they wouldn’t be so shocked and awed. What a nightmare we are living.

    Liked by 1 person

  7. Doc, you are so right. But just the same… Breathe out — imagine all the bad things going out the window with that breath. Breathe in — hope and happiness.
    I actually did ask a doctor to let me read what he had written. It was so long ago I don’t remember anything except that he wouldn’t let me. Mega hugs.

    Liked by 1 person

  8. I try to stay healthy so all she has to do is give me a gold star! My husband was talking just the other day about how his senior partner took patient notes when he first joined the practice in 1981. She was the first woman grad from Duke Medical School in the late 1930’s and close to retirement – she wrote her patient notes on any paper she could lay her hands on: envelopes, the backs of letters. announcements. Hubs said when he opened a patient file, he had to figure out not only what she’ d written but when.

    Liked by 1 person

  9. .. OR:
    1) Ask the patient to write up the record themselves;
    2) Tape the conversation rather than taking notes, thereby hopefully avoiding injecting the doctor’s subjective / opinionated perspective into the record. I wager there’s an app that can easily transcribe…?
    My 2 cents 😉
    Well done, Victo, for bringing this to light!

    Liked by 1 person

    • If patients could write their own notes I would be in heaven! The transcription apps have their problems… like they are unable to click all of the government mandated “meaningful use” crap we have to do. For instance, I used to be able to type out: Mom died age 92 due to old age but also had breast cancer diagnosed at age 55. Father died age 68 due complications from diabetes. He had his first heart attack at age 46.
      In “meaningful use” I can no longer write that out. Under the mother tab I have to click breast cancer. Under father I have to click on diabetes and coronary arty disease. All of that other rich detail is lost because the government decided that it would be better this other way. Meanwhile, it is important that the patient’s father had a heart attack before the age of 50 but I have no way of noting that. Same thing with the mom’s breast cancer.

      Liked by 2 people

  10. My latest specialist always dictates his note to my GP while I’m still in the room He always refers to me as a ‘very pleasant woman’. As in, “Thank you for referring me to Ms. L, a very pleasant woman”.

    I often wonder if the term ‘pleasant woman’ is code for something else… 🙂

    Liked by 1 person

    • I like those specialists. “As you know, Mrs. X is a delightful woman with Y and Z.” Sometimes I KNOW that Mrs. X is most certainly not delightful but they say it anyways. Now I wonder if it is because they dictated the note in front of her! 🙂

      Liked by 1 person

  11. I always go with my mother to her appointments. Our poor doctor probably wishes we’d cut the chatter so she could get some work done. However, on the bright side, I often take her a jar of home-canned chili, flowers from my garden, or once, a copy of my book. I hope it’s not an embarrassment.

    Liked by 1 person

  12. My heart aches for you. And breaks for you. The last doctor visit I had ended with a hug. Totally different structure from what MD’s deal with. I wish MD’s could take back control from insurance companies and pharmaceutical companies.

    Liked by 1 person

  13. Tis my struggle too Doc, staying human…I am a writer of my notes, too, can’t stand point and click, I even use my patients name in the text….Sally presents for recheck of hypertension, etc. I write all of their names at the start of my notes and in my Discussion which is printed for them. I never say “patient.” It’s like my own personal protest against the machine.

    Liked by 1 person

  14. My personal reflex is to formulate a joke so I can at least have a laugh. Even if that laugh is sarcasm at my own expense. Then I patiently wait for my coffee break.

    Then you focus on reality again and when the joke is good enough you can at least grin before feeling like swearing…

    Liked by 1 person

    • I tell patients at the beginning of the office visit that if I seem confused or super slow or start cussing under my breath to not be alarmed, that it is the new EHR and not them. Makes us both laugh, which helps. 😉

      Like

  15. Just a follow up after seeing my GP. He honestly doesn’t know about this form unless you are referring to the one for people over 65. He showed me what he wrote and no pop up boxes appeared. His kindly advice to you is not to get upset over something out of your control but to do your best to adjust. Life is just too darn short. ❤

    Liked by 1 person

  16. I sent your article to our granddaughter because I knew she would understand. Her comment was great. She said her physician’s report included a comment about what the patient ate “because there was no click for that.” There still are human beings out there. ❤

    While I am at it, I wanted to share a longer comment I could not justifiably condense. I am reluctant to include the link, but maybe after you read it, you can delete it.

    https://fortheinvisible.wordpress.com/2016/11/22/the-face-of-courage/

    Liked by 1 person

  17. Interesting question: Are we losing our humanity?
    Or are we just going back to the most human part of (in)humanity? Me, me, me! And only me. And screw, or kill anyone who stands in the way.
    Sometimes I think war is the ultimate human activity. The last one (WWII) killed 60 million people. And since everybody has forgotten we are getting ready to go at each other’s throats.
    How many will it be this time? 600 million? one, two or three billion dead?
    (Have a great week meantime!) 😉

    Liked by 1 person

      • It is. Totally. The cycle end when there are enough casualties, or not enough survivors to fight. Then they look at each other and say: “Okay, this one was close. Can’t have another one can we?”, and then they forget, and it starts to build up again… 😦

        Liked by 1 person

  18. I remember the British health system when I was a kid – you could front up to casualty and get treated with kindness and compassion. My doctor, Bertha Bryant, was brusque, kind and spoke the truth, no sugar-coating. She was, by the way, one of the first medicos into the Bergen-Belsen concentration camp. My father, in hospital, was in a ward which was pristine, the ward sister was to be fears, but the standards of hygiene and service were first class. Sadly we’re being reduced to dollars and cents, the humanity being chipped away. As it happens,I don’t have a doctor. Last time I went it was a waste of space. As I’m 69 I guess I’ll probably end up visiting medicos at some stage, but I query everything I’m told and prescribed.

    Liked by 1 person

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