[EXTERNAL] [IMPROVEDX] The right dx

Lenny Hoffman lenhoffman39 at GMAIL.COM
Fri Jan 24 15:13:57 UTC 2014


I agree with Dr Sawyer. Too often I see physicians emr records where the
default is chosen (pre-determined physical findings such as "chest clear to
auscultation )yet the patient clearly has dyspnea and wheeze.
I do not have the luxury of a scribe but have seen how this works when I
was a patient recently.
I love to tell the story of a 4yo whom I have known for several years. When
we started our emr program, he put his little face between me and the
computer and said, "Dr Hoffman, I am here"
It is not easy go back and forth with past records and not being able to
open different screens at the same time.
I am also graded on my completeness of putting in new codes, each requiring
one code at a time and this needs to be completed along with a summary to
the patient at the time the patient leaves the office. I can check my grade
daily.
I do the summary and if the printer is working or fast enough and the
printers are not in use, I can get this out to the patient before they
leave.
Our computers freeze sometimes . These experiences are not different from
speaking with other colleagues but we started with computer use maybe 7
years ago, early, and I am sure there may be better programs and certainly
faster connections.
Even with safety measures, I hear stories of outside intrusions even with
our in house computer expert who provides us with excellent service and
protection.
And I love computers.
So it is my opinion that at the present state of EMRs ,we are not able to
concentrate on the patient and condition for which they are seeking help as
well as I was able to do so before computers.
Leonard Hoffman MD



On Thu, Jan 23, 2014 at 9:09 PM, Dr Wil <dr.will at fuse.net> wrote:

> That is why scribes are necessary in the era of EMR so clinicians might be
> able to use decision support tools and spend more time with the patient and
> be able to bill for the medical service in order to stay in business.
> What does everyone else think?
> Will Sawyer MD
>
> Sent from my iPad
>
> > On Jan 21, 2014, at 12:36 PM, "Graber, Mark" <Mark.Graber at VA.GOV> wrote:
> >
> > This is an important comment, and thanks Victoria for both sending the
> note to your physician and mentioning it on this forum.  In an ideal world,
> care would be both patient centered AND knowledge-based.  These goals come
> into conflict a lot these days - many physicians don't take the time to
> take advantage of decision support resources, and some believe that their
> patients will perceive them negatively for doing so.
> >
> > Hopefully someday we will get to the point that physicians use decision
> support routinely, and patients see the value in this, as you did.  The
> trick is to somehow maintain the patient-centered focus, and not spend so
> much time at the keyboard that the patient feels neglected.
> >
> >
> >
> > ________________________________
> > From: Vic Nicholls <nichollsvi2 at GMAIL.COM>
> > Reply-To: Society to Improve Diagnosis in Medicine <
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Vic Nicholls <nichollsvi2 at GMAIL.COM>
> > Date: Mon, 20 Jan 2014 20:13:58 -0500
> > To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> > Subject: [EXTERNAL] [IMPROVEDX] The right dx
> >
> > Question for the medical professionals on this list.
> >
> > I have a doctor who looked up something in UpToDate at my last
> > appointment months ago. She gave me another test which showed a problem.
> > I remembered that.
> >
> > I put a note to her, coming up at my next appointment, saying that I
> > hadn't said so but that I appreciated her doing that. I said there are
> > those who wouldn't do that in front of a patient, but the fact that she
> > went searching for an answer on my account really made me feel like she
> > put my welfare and patient care first.
> >
> > Do doctors really appreciate that? She hasn't said anything but I know
> > she got it. I have asked for the bosses of doctors before and given them
> > things that I said I appreciated about them and how much it meant to me.
> >
> > Thanks,
> >
> > Victoria
> >
> >
> >
> >
> >
> >
> > Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
> Society for Improving Diagnosis in Medicine
> >
> > To unsubscribe from the IMPROVEDX list, click the following link:<br>
> > <a href="
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> > </p>
> >
> >
> >
> >
> >
> >
> > Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
> Society for Improving Diagnosis in Medicine
> >
> > To unsubscribe from the IMPROVEDX list, click the following link:<br>
> > <a href="
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> target="_blank">
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
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> > </p>
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>
>
>
>
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
>
> To unsubscribe from the IMPROVEDX list, click the following link:<br>
> <a href="
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1"
> target="_blank">
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> </a>
> </p>
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