Some People Don’t Think Like Doctors (!)

This may come as a surprise for people with business degrees:

Doctors don’t really care when a test was ordered. We care about our patient’s chest X-ray or potassium level the very moment the test was performed. We also don’t care (unless we are doing a forensic review of treatment delays) when an outside piece of information was scanned into the chart. We want to know on which day the potassium was low: Before or after we started the potassium replacement, for example.

In a patient’s medical record, we have a fundamental need to know in what order things happened. We don’t prefer to see all office visits in one file, all prescriptions in another and all phone calls in a third. But that seems to be how people with a bookkeeping mindset prefer to view the world. In some instances we might need that type of information, but under normal clinical circumstances the order in which things happened is the way our brains approach diagnostic dilemmas.

Yes, I have said all this before, but it deserves to be said again. Besides, only 125 people read what I wrote about this six weeks ago, while almost 10,000 people read my post about doxepin.

Patients’ lives are at stake and, in order to do our job, we need the right information at the right time, in the order we need it, even if the bookkeepers prefer it a different way.

We are the clinicians. When non-clinicians design our “workflows”, things can work out just like the Boeing 737 MAXX. The engineers thought their new autopilot was brilliant, but it made no sense to pilots. Planes crashed and people died. Boeing at first tried to blame the pilots. Healthcare systems are still blaming providers when the systems we work with don’t work for us.

What percentage of medical errors occurs because we can’t quickly find the information we need – or, worse, because our systems are so clumsy that we don’t have time to enter it according to the prescribed workflows? The statistics may not reveal the true magnitude, just as the Boeing disaster was not immediately attributed to the autopilot. Many medical mishaps are probably blamed on human error instead of the EMR.

We deserve better and our patients deserve better. People around me think I don’t like technology. That’s not true. I just have no patience for technology that doesn’t work. If online banking worked like my EMR (Hi, Greenway!), the banking system would collapse. Facebook, TikTok, Amazon, Google, WordPress and my old iPhone SE seem to work just fine. Why can’t EMRs?

13 Responses to “Some People Don’t Think Like Doctors (!)”

  1. 1 Eva Hnizdo May 3, 2021 at 5:13 am

    Wow, I must say my computer system ( NHS GP in the UK) was much more user friendly. I am retired now.

  2. 2 summonzeus May 3, 2021 at 12:28 pm

    OhioHealth System in Central and SE Ohio uses and addresses the problems you mention. The graphing function of test results gives a much better view of the patient.

  3. 3 johndykersmddykerscom May 3, 2021 at 1:03 pm

    I can’t tell whether you have any interest in solving the problem or whether you just want the issue?

  4. 4 Sue May 4, 2021 at 10:09 pm

    I love your blog. I read it through email most every week. I hear you. And I will try to amplify your message as much as little I can. But, I will. Keep on.

  5. 6 Dan Hayes May 5, 2021 at 9:26 am

    same topic, slightly different concerns. i am now doing a lot of 2nd opinions/consults. The patient information can be in one of 3 different places in my EHR:

    a. in our regular chart notes IF the outside doc uses the same EHR

    b. in a place called “CareEverywhere” – and i must say i don’t understand the difference between this and just showing up in our regular chart notes, excepte the CareEverywhere is harder to sort through with lots of extraneous stuff that encompasses an occasional important outside doc note or labs/imaging results

    c. in a tab called “media” in which anything sent to us is scanned in. To their credit, the people who do the scanning try to get the information into the right sub-tab with proper titles and dates, but often they misfile or mislabel it, and as you point out – they date it when it arrived, not when it was done.

    so I usually must spend at least an hour wandering through all 3 places to put together a cogent history, unless there is one comprehensive, up-to-date, and well written note from a referring doctor, which I must say is not the norm.

    re: “any interest in solving the problem” – I have tried to make suggestions, but the “updates” usually just move one thing to another place, with few if any substantive changes relevant to many of our complaints, so I’ve frankly given up.

  6. 7 R Stuart May 5, 2021 at 4:47 pm

    But EMRs do work just fine – when you realize that they exist solely in order to use the free labor of physicians to collect data that will be monetized to the tune of trillions of dollars.

    They never were and never will be in any way about providing better patient care.

    We, as physicians, don’t deserve better, because we continue to ignore the evidence right in front of our eyes and buy into the Big Lie that our needs and concerns, and those of our patients, are at all relevant to this discussion.

    • 8 John R. Dykers, Jr. MD May 5, 2021 at 10:08 pm

      Amen. Let’s push for adoption of the Medical Care Restoration Act. Compared to M4a, the Medical Care Restoration Act is smoother, more effective, Voluntary, Universal, improves quality of care, decreases cost, moves economic power, authority and responsibility, to a Dr/Pt relationship which is healing, and away from hassle bureaucracy of government, insurance or hospital interfering with healing. MCRA diminishes defensive medicine, encourages learning, preventive medicine, and patient care; restores non monetary rewards to practice of medicine and surgery, requires physicians to earn their keep, restore honor, affection and effectiveness to the healing professions. MCRA text is 10 pages 5×7 and 16 font in Chapter 2 of “The Price of Eggs Is Down”. I think you will appreciate other chapters too. I hope you will add your voice to permissive legislation that does not require repeal of ACA

    • 9 Nell Nestor May 7, 2021 at 3:24 pm

      They do work very well for that.

  7. 10 Marilyn May 6, 2021 at 8:49 am

    I posted this to a group I am in Digital Tech Health Tech Innovation. You may want to see what others are saying And join the grouo.

  8. 11 CrownofMaineNP May 6, 2021 at 10:56 am

    Very True! I want it to work not find a “work around” 😉

  9. 12 Leslie Jaine May 12, 2021 at 2:41 am

    The airplane analogy does not escape me. I have compared using EPIC to driving a Boeing jet down the block to get a gallon of milk.

    • 13 Christina Pinkerton May 12, 2021 at 8:39 pm

      Be glad you’re not using NextGen. It’s like using a garbage truck held together with bandaids.

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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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