Wednesday, February 6, 2013

If You Don't Like It, Use The Hospitalists

It happened, of all times, when I was in the car driving the kids to violin practice.  My pager buzzed with a message from one of the medical floors.  I waited till the car was parked, and dutifully pecked the numbers on my cell phone.

Hello doctor, we have your patient, can you please put admitting orders into EPIC?

I, of course, like most doctors, wasn't sitting by my phone waiting at a computer terminal.  I explained that I would have to give orders over the phone.  There was a pause.

I'm sorry Doctor, new hospital policy, all orders must be placed by a physician.

I already knew that there was no use fighting it.  This was just another onerous policy piling the work on the primary care physician's back.  The last time I faced this situation the nursing supervisor couldn't have been more clear...If you don't like it, use the hospitalists!

I explained that I wouldn't be able to sign on to EPIC for a couple of hours, and told her I would call back.  When violin practice was over and the kids were tucked sleepily in bed, I signed on to the EMR to admit the patient.  Browsing the med list in the computer, I quickly realized that the ER staff hadn't reconciled the medicines correctly.  The list on record was outdated by years, a remnant from the last admission.  But since that time the patient had stayed at a nursing home and had several changes.  Sitting in my office at the house, I had no way of knowing the right doses. 

So now I had to call back to the medical floor, have the nurse rustle through the paper chart and find the medicine list from the nursing home.  Then, because she was not allowed to enter the orders herself, she had to read off all twenty medications and wait while I entered them one by one into the computer.  It took forty five minutes in all.  Forty five minutes in which neither the floor nurse nor I were actually taking care of patients.

Now it's safe to say, we wouldn't have had this problem if the nurse or physician had reconciled the meds correctly in the ER (like they were supposed to).  I could have just pointed and clicked. But they don't have enough time either!  They can barely appropriately accomplish their jobs.

As the parade of health care reform travels on and the electronic revolution continues, our most valuable and scarce resources are asked to carry the largest load.  And we all know that there isn't going to be a physician uprising.  This is my new reality.

How can I, a physician responsible for twenty five hundred people, spend an extra hour on nonclinical administrative work for each admission?  Maybe I could handle that kind of workload if I was taking care of a patient population a tenth of the size.

Hey, wait. 

There's an idea. 


Craig Erbach said...

Dr. Grumet,

I'm a first year medical student, I've been following you for a few months now, and I was saddened by your post Monday about you giving your notice to your practice. I sometimes question the motivation of my fellow students to practice medicine, some seem to be in it for the wrong reasons. Someone like yourself, who seems to have his priorities in's tragic to see the medical field lose someone like you.

For four years before I started school, I used to work for Epic, and then consulted on several epic installations. The rush to meet meaningful use can mean that the installation and training are less than perfect. I'd like to talk to you about this post, it makes no sense to me. If you're at all interested, please let me know. Even if it doesn't change your decision, fixing this problem might help out others in the same situation.

D said...

I won't spoil your thunder but think I know where you are going- GOOD for you! Please keep us posted on your new endeavor.
I'm thinking of doing something similar down the road.

NurseWriter said...

Another example of JCAHO driven madness.

NurseWriter said...

Another example of JCAHO driven madness.

Ron said...

The situation is bound to improve once the federal government takes over health care. ;)