Saturday, August 18, 2012

Dogma Bites

I like to laugh at cardiologists.  They always seem to be pushing some new treatment, especially vitamins.  One only has to look at the Vitamin E, Folic Acid, or  the Vitamin D fads.  But all joking aside, while the field of cardiology may jump the gun from time to time, they are experts at scientific method.  That's why as each of these miracle treatments have been studied and shown to be non beneficial, the recommendations changed.  It's really straight forward: generate hypothesis, test, and draw conclusions.  The rest of the scientific community should take notice.

Yet, there are times in medicine when we fail to adhere to such basic principles.  One only has to look as far as the doctor's exam table. Now a days, perched upon it, is a computer screen in place of a paper chart.  Is there proof that electronic medical records are better?  We know that they are more expensive.

Now don't get me wrong, I've been using EMR's since 2003.  I learned five different systems over the years, and use Epic, Misys-Allscripts, and Cerner currently.  I adapted, and no longer find them an impediment to care.  But the truth is, I would go back to pen and paper in a heart beat.  I can't tell you how many times I've seen user generated errors cause harm to patients.  Recently, I witnessed the quality of care spiral in a local hospital as physicians and nurses scurried to negotiate a new system. 

When a patient is transferred to the nursing home from a hospital with an EMR, it takes untold hours to traverse the useless minutia and mine the important data. 

But all this would be worthwhile if there was one iota of proof that the large expenditures improve quality, cut costs, or increase patient satisfaction.  Please, anyone, show me the data!  Instead, we have a series of suppositions made by administrators, politicians, and starry eyed physicians who no longer get their hands dirty with actual clinical care. 

What we have is dogma.

And the problem with dogma is that it doesn't bend to science.  We run, like herded cattle, oblivious to the cliff in front of us.

Of course,  reality won't be so dramatic.  Maybe we creep towards a mild and continuous decline.  Either way, the results will generally be the same.

Prepare for the abyss.


John C. Key MD said...

I use an EMR without difficulty. So be it. But it makes patient care more difficult, not easier. It gives rise to the common complaint about lack of eye contact ("the doc just stares at the computer") and I must be vigilant to check all the right boxes.

I work for a state agency. I am convinced that the love of EMR shown by those in authority derives only from ease in monitoring of those of us on the front lines. My agency has minimal interest in outcomes but maximal interest in box-checking, lab ordering, medication usage. To heck with patient needs, appropriateness, outcomes. But if you don't order the correct tests, or put the 18-year old on a statin and a baby aspirin, and I will have to submit a "corrective action plan" after the audit is done. Individiualized patient care? Fuhgeddaboudit. If I even try I will have to submit pages of justification since the non-clinically trained auditor has flagged my work as "noncompliant".

The great advantage that I have is that I can clearly see what a fully developed program of nationalized health care will be like.

Like you said, dogma survives.

Anonymous said...

DO doctors anywhere actually do "hands on" care with patients anymore? It's been so long since I have been to a doctor who actually examined me or placed his hands on me that if it were to happen now I may think he is making a pass. Isn't it sad that it's come to that? Indeed they do sit with their back to patients staring at a computer screen. When they are finished no need to hand us prescriptions they have already electronically ordered them at our pharmacy. Tests have been ordered and boxes have been checked. Then it is "Have a great day and call if you need anything."...It makes you wonder sometimes if they really, now days, need all that education and training to just follow directions on a computer screen.