A Country Doctor Writes:

The patient, I surmised, was the one in the wheelchair, with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter.

I introduced myself. I had been right about the other woman being her daughter.

It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a scribble sheet for the doctor and the medical assistant were piling up in the pocket of my office door.

“So, what can I do for you today?” I asked.

The woman in the wheelchair gave me a sturdy look and said:

“Did you read my chart?”

My mind raced, thirty years into the past and back again.

As an intern and resident admitting patients to the hospital, I would routinely read up on the patient’s paper chart before entering the room. Each admission took as long as it needed, and the only time pressure I felt was usually my own. The emergency room doctors had already ordered the initial treatments each patient needed.

In practice before computers, I would glance at the problem list and flip through the last few notes, labs and imaging tests while pausing in my office or at the nurses desk, sometimes actually while walking toward the exam room.

Now, with computers that go black after just a few idle minutes, I’d have to log on in order to see any information, and the moments that takes feel like forever. Besides, I can’t very well sit in the last exam room I used and do this, since my nurse needs to room the next patient.

Also, now, with all the checklists we must complete in even the simplest visit, there really is no time during or in between visits to actually sit down and “read the chart”; our time is so pressured and the medical records have become so bloated that we end up just asking the patient, because the pertinent information drowns among the mandated minutia.

“No, there is seldom time to read the chart anymore”, I said.

My patient sighed and gestured to her daughter, who recited her medical history in a monotone voice as if she had done it too many times to count.

The woman had leg cramps, and it was probably because of low magnesium. Her exam was fairly similar to the last note by her own doctor. I did compare my findings and his.

So I prescribed magnesium and two days later we got a call that that had done the trick.

But I don’t think she will ever accept that when she sees a different physician, they will talk to her first, before deciding if it would be worthwhile to steal the time from someone else’s appointment to sit down and read her chart.