A Country Doctor Reads: September 7, 2019 – Workarounds in Healthcare, Empathy in he Age of the EMR, US vs Swedish Postoperative Pain Management

The American Medical System is One Giant Workaround – NYT

The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait.

So begins an article in Friday’s New York Times. How many times have I used or thought of the word “workaround” recently? Lots, certainly in my personal life, with an older house, an older car, in far northern Maine. But as a descriptor of our country’s entire healthcare system? Well, to be honest, there’s a lot to that notion…

The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.

As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list.

www.nytimes.com/2019/09/05/opinion/hospital-workaround-health-care.html

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Empathy in the Age of the EMR – Danielle Ofri, MD

Danielle Ofri has another article on the plights of today’s physician, this time in The Lancet. I had offered some feedback on her article “The Business of Healthcare Depends on exploiting Doctors and Nurses” in The New York Times some months ago, and I ended up joining her mailing list. This just arrived in my inbox and it certainly resonates:

Many of us physicians muddle through our clinical encounters in this manner. We’re half-listening, half-typing, half-processing what tests we’ll need to order, half-chiding ourselves about an oversight from our last patient, half-ignoring the red-flag alerts that keep cropping up, half-thinking about the next three patients in the waiting room, and half-pondering whether one of the EMR buttons could do something practical like conjure up a cup of coffee and a sandwich.

 The only thing that’s not diminished by half is the feeling that we’re cutting corners on every front and scraping by with mediocre medical care. 
— Read on danielleofri.com/empathy-in-the-age-of-the-emr/

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US, Canadian and Swedish Postoperative Opioid Prescribing – JAMA

I had an open appendectomy in Sweden back in 1972, weeks after returning from my year as an exchange student in Massachusetts. I remember distinctly that I was in relative agony but never asked about my pain level or offered anything for pain while I was recovering in the hospital. I remember spending a few days there. Then, as now, the Swedish healthcare system is lean on interventions and generous with bed-days, so by the time I was discharged I didn’t hurt much at all.

I was aware that Swedish patients to this day don’t receive as much pain medication as Americans, but I had no idea of the magnitude. This week I read an article that pegs the numbers – a seven fold difference:

This cohort study determines whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada and Sweden.

In summary, we observed differences in opioid prescribing after low-risk surgical procedures across 3 countries in North America and Europe. Patients treated in the United States and Canada received opioids after surgery more often and in higher doses compared with patients treated in Sweden. These findings highlight opportunities to encourage judicious use of opioids in the perioperative period in both the United States and Canada. Understanding the societal and cultural factors that influence these prescribing patterns could inform areas of further research and identify targets for future interventions.
— Read on jamanetwork.com/journals/jamanetworkopen/fullarticle/2749239

2 Responses to “A Country Doctor Reads: September 7, 2019 – Workarounds in Healthcare, Empathy in he Age of the EMR, US vs Swedish Postoperative Pain Management”


  1. 1 Dr. Jim September 11, 2019 at 9:34 pm

    I read “Empathy in the Age of the EHR” with interest. As for myself, I’ve just about had it with the EHR. All of it is based on lies, and the financial interests of others.

    Looking at my notes from ten years ago, I want to cry. Short, to the point, full of ACTUAL value for future readers. Will anyone in two years from now, never mind ten, gain anything of value from the gobbledegook in my EHR notes? I doubt it.

    I just saw a patient with abdominal pain. The attendants were considering diverticulitis, because the night radiologist told them to do so. Five “providers” had preceded me, none had discovered the TAH-BSO for cancer THREE MONTHS AGO, or the 28 radiation treatments. Of course, they can’t be blamed for the latter, because the XRT is in a separate EHR, something to do with fraud prevention or Stark Laws.

    Of course, talking to the patient would have unlocked the mystery. But that takes precious time that could be spend coding, documenting someone else’s Review of Systems (does anyone believe anyone asked those questions, EVER?), or figuring out the correct order sentence when none of them are exactly right.

    We are witnessing a slow-motion catastrophe. While some of us who have been taught how to be a doctor are still around, the effects are minimized. When we’re gone?

    At least all the Level Ones will become Level Twos, and all the boxes will be checked.


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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