Why is it that every visit note has to rehash past medical and surgical history, active problems, allergies and sometimes even long narratives about the initial presentation of the problem at hand and long lists of prior testing?
In the electronic health record, when we start a new encounter, those things are usually right there in a scrollable sidebar. And when we print or fax completed office notes from the EMR, most systems could automatically include all those lists, if only as attachments.
Imagine the possible time savings and mental health benefits (less burnout) if, during visits, doctors wouldn’t need to click “import to note” a kazillion times, indication we had rigorously reviewed everything in the sidebar (because how much does anyone really think we can do in the few minutes available in each encounter for review of past medical, surgical, social history and so on?)
And during return visits, or just scanning old notes, we could quickly and easily catch up on the progress of the patient’s case if all the fluff didn’t gum up the chart note. Because in most notes in most cases, those things are fluff. If a diabetic has started on a new medication and they come back to review their blood sugar log, which is improved, and they report no side effects, those things we pretend to review in detail really are fluff. Of course we need to cover them in more detail with annual visits or with brand new problems, but most of what we do is following up on specific issues in the care of specific diseases.
Let us get right down to the purpose of the visit instead of trying to, or pretending to, do everything for everyone every single time they come in.
A Country Doctor Writes: 
Patients sometimes remember details differently, and I often review them with them to assess their interpretation of their medical conditions and what they know of their medications. Also, for some reason, some patients take their medications differently from what’s documented. The issues list (which also happens to be their past medical history) is fluctuating and changes.
But I guess the perspective changes as an inpatient medical practitioner vs an community medical practitioner. I see a lot of those who have acute fluctuating changes. It is indeed frustrating when long stays have copy-pasted notes.
Depending on your medical record program also determines whether this past medical history is at hand. Surgical notes, for example, are notorious for just having the active issue in SOAP format. So as an internal medicine doctor, it becomes a trawl through 5 years worth of notes to eventually figure out where their past medical history from the initial note is (often not labelled as such in the subject) and the patient sometimes cannot recall their own medical history or say the most frustrating “it’s there in my notes! you should read it!” (yes, it is. but it takes me 4-5 hours to eventually make heads or tails of it, where a summary of a complex history from the patient themselves would take 30mins in comparison.)
Is it necessary for every visit? No. But I do prefer to have at least one note every 3 episodes to have the full background so I don’t have to flip back 15 “screens” to find the relevant history.
My emr is apparently not as fancy as yours. We don’t have “importable” histories. And copy-paste is rife with errors for those who don’t verify them.
Also a mini-rant on the other side of yours. 😀
I agree with your premise wholeheartedly,but then again, if we are being honest, we all know the EMR is for insurance and reimbursement, not for better patient care!
But it is killing doctors and causing medical errors and patient harm…
30 years ago at the start of my solo IM medical practice, a busy day would be making hospital rounds on 3-4 patients and seeing 20 people in the office.
Now, no hospital rounds (for varied reasons) and a busy day is 12 patients.
Note bloat for insurance companies has not resulted in improved patient care if we are 50% LESS PRODUCTIVE.
The provider is burnt out and the customer is frustrated. In no other industry (perhaps airline travel) has this happened because of over-regulation by government and insurance
There is no solution as we have the worst parts of socialized medicine with big government, big insurance and big pharma stealing the public’s time