health care dollar, when to my dismay I was hit with a conundrum. The patient in front of me was a young healthy female with right lower quadrant abdominal pain. As I recklessly took a history and examined the patient I formed and incomplete and cost ineffective differential. Her belly was definitely tender. She had a low grade temperature. The list of possibilities danced through my economically unsavy brain. Appendicitis, right sided diverticulitis, kidney stones, gynecologic issues.
Then the answer hit me like a ton of bricks. Gleefully I went to order and expensive cat scan of the abdomen and pelvis. I reached over and picked up the order form and my hand gently moved to the breast pocket of my lab coat. And then it happened...wait for it...wait for it....there was nothing there. I ran, in a quandary, to my desk to find a pen to fill out the form. My desk was picked clean.
And then....then things started to click. My medical assistants and secretaries had been roving the building looking for pens for months now. Slowly but surely they had stripped the doctors office's.
One by one the great pen migration had begun. Months ago. Doctor's in exam rooms and hospitals everywhere had started to feel the pinch. I didn't even flinch the other day when, on my way into the hospital, I was approached by a former friend and colleague. He had a rabid look in his eyes and a uncanny desperation. I quickly brushed him off and assured him that I wasn't hiding any extra pens in my lab coat.
But why...why had the pens in medical facilities become as rare as a primary care doctor who sees his own patients in the hospital?
It was the government. The government had been working for years to curb pharmaceutical influence on our impressionable physician work force and made it illegal for drug companies to use pens as marketing tools. The logic was impenetrable. Ignorant, careless, bonehead physicians were being coaxed to use expensive, harmful pharmaceuticals to the benefit of the industry and the harm of patients everywhere.
The government, however, had no idea how fortuitous this ban could be. Strapped (and cheap) physicians struggling to make ends meet would be very unlikely to replace this free revenue stream by buying more office supplies. As the great pen migration continued physicians would find themselves unable to do the very thing that bureaucrats and reformers have been trying to stop for years. Write new orders!
After all the most expensive technology in medicine is the physicians pen. Now physicians would no longer be able to write for cat scans, mris, and expensive chemotherapy. The health care crises was solved!
And indeed as I struggled to find a writing utensil I did momentarily contemplate skipping the CT Scan and just putting my patient on antibiotics. After all if she actually had appendicitis it would eventually rupture and we would find out soon enough. Right?
But the Obama administration made one fatal error. In its zeal to promote Emr's it forgot that there is one glitch....electronic order entry.
I skipped...nay I ran to the nearest computer. Within minutes I had ordered the cat scan electronically.
Another day...another dollar spent. I guess I could get to like this EMR thing!
Boy....I think I have been reading too much Dr. Rich!