I Am a Decision Maker, Not a Bookkeeper

Perhaps it is because I love doctoring so much that I find some of the tools and tasks of my trade so tediously frustrating. I keep wishing the technology I work with wasn’t so painfully inept.

On my 2016 iPhone SE I can authorize a purchase, a download or a money transfer by placing my thumb on the home button.

In my EMR, when I get a message (also called “TASK” – ugh) from the surgical department that reads “patient is due for 5-year repeat colonoscopy and needs [insurance] referral”, things are a lot more complicated, WHICH THEY SHOULDN’T HAVE TO BE! For this routine task, I can’t just click a “yes” or “authorize” button (which I am absolutely sure is a trackable event in the innards of “logs” all EMRs have).

Instead, (as I often lament), I have to go through a slow and cumbersome process of creating a non-billable encounter, finding the diagnostic code for colon cancer screening, clicking on REFERRAL, then SURGEON – COLONOSCOPY, then freetexting “5 year colonoscopy recall”, then choosing where to send this “TASK”, namely the referral coordinator and , finally, getting back to the original request in order to respond “DONE”.

The authorization for the colonoscopy referral does require my clinical judgement: My patient may not be medically stable for their routine colonoscopy because of a recent heart attack, or they may have already had a diagnostic colonoscopy at another hospital because of a GI bleed, or they may now have a terminal illness that makes screening for colon cancer moot.

But, please – when we can land robots on Mars – give me an easier way to say “yes” or “no” in my multimillion dollar system!

6 Responses to “I Am a Decision Maker, Not a Bookkeeper”


  1. 1 OlRedHair September 18, 2021 at 6:57 am

    Couldn’t tasks like this that don’t require a medical judgment be performed by an Assistant?

  2. 4 Dan Hayes September 18, 2021 at 7:51 am

    Absolutely correct. The enormous potential benefits of EMRs have been diluted, no…squandered… by poor programming focused on getting reimbursed as close to fraud as possible rather than improving patient care and streamlining caregiver workload.

  3. 5 Claire Barker September 29, 2021 at 10:56 am

    I am retired now for 3 years, but I really feel your pain. Instead of just practicing medicine/geriatrics I was always keenly aware of billing, coding, time and excessive documentation.
    36 years ago, I kept up the past medical history at the front of the chart, med list and then wrote or dictated a pertinent SOAP note. Billing was my initials and doctor number next to the date.
    By the end of the my practice I felt like I was doing my job plus everybody else’s job.

  4. 6 Robert Stuart October 4, 2021 at 1:17 pm

    I really don’t think this is a technology problem.

    All those worthless steps are there because someone – an administrator a physician, an insurer – demanded that they be put there. A simple “yes or no” colonoscopy question could easily be added to any EMR, but it would be completely unacceptable to those who run the show.

    Have to wonder why these requests aren’t going first to the “referral coordinator” who asks you “yes or no,” and then does all the rest. So many offices are set up to dump as much work as possible on the primary care docs.


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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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