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A Country Doctor Writes: IN PRACTICE : Starting, Growing and Staying in the Medical Profession – eBook and Paperback

The second book in my A Country Doctor Writes series is now available.

This book is more specifically written for a medical audience than CONDITIONS, which has many general interest essays. IN PRACTICE contains lessons and reflections from colleagues’ and my own practice and also essays about how to be the kind of doctor each patient needs. Several chapters on professional burnout make IN PRACTICE relevant to both seasoned and aspiring medical providers.

If We Can’t Have a Universal Electronic Health Record, We at Least Need a Single, Universal, Medication List Plug-In

Medication errors are serious business. Transitions of Care are dangerous, in large part because of the many pitfalls in medication reconciliation.

One of my clinics is collecting the extra money Medicare offers for having care coordinators track hospital discharges, reaching out to patients to make sure they have what they need, and poring over discharge summaries to reconcile the hospital and the outpatient medication lists. They also keep track of pending test results, all in an effort to make the transition from inpatient to outpatient care safer.

My other clinic doesn’t do this. The medication reconciliation is done by the primary provider-nurse team during the sometimes hectic office visits.

I see too often that a patient admitted through the emergency room has the wrong medication information entered in his admission history and orders. Then the hospitalist changes what was incorrect in the first place and the patient ultimately gets discharged with new orders to double up on something they already took in exactly the new dose, or to continue a medication that they already may have stopped.

The technology to avoid such errors already exists.

In both my EMRs, I can click on a virtual button that lets me see in full detail what medications have been prescribed electronically, as long as we record the patient’s consent to do this. I can then manually import this information into my own EMR’s medication list.

I don’t believe our local hospitals can access this information in the middle of the night from the emergency room. And I can’t access it if there is a delay at the front desk in documenting this and other consents lumped in with it, which all require annual updating.

If we really must tolerate the non-interoperability quagmire of Epic, Cerner and all the small EMR companies, I think in the name of patient safety, we should at least do this:

Make all these for profit companies use one universal medication module that automatically updates through the already existing technology. This would save lives and prevent countless medication errors. It would also save a lot of time, effort and frustration in our already stretched-too-thin primary care clinics.

And let every hospital EMR in on this, too.


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”.

First Book: Paperback/eBook

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