A Country Doctor Writes:

I had to get a PCR test for Covid today (I was negative) and before I had the pleasure of getting the swab inserted in my nasal passages I was subjected to a whole series of even more intrusive probings.

The questions on the multipage form included sex at birth and presently (just like our new EMR prompts us to document in every visit), sexual orientation, income bracket, ethnicity, food insecurity and living situation.

And this was just for a ten second nasal swab by a medical assistant.

If I had come for a primary care appointment with a medical provider, I would have received questionnaires about depression, anxiety, alcohol use, smoking, domestic abuse and maybe more.

I have several concerns about this barrage of questions before you even meet the provider. As clinicians we know that patients don’t always tell us the whole story. That is why we do pregnancy tests on nuns with abdominal pain, for example. We are supposed to use all our professional interviewing and communication skills to establish trust with our patients. That can be extra hard after they are first bombarded by the support staff with extremely personal questions.

This well intended systematic inquisitiveness is extremely insensitive and I seriously question its reliability. It seems odd to me that medical students and other staff categories have to take classes in cultural sensitivity and at the same time have a requirement to probe for personal secrets early in their interaction regardless of the age or cultural background of our patients.

I believe the statisticians are given too much power over how the clinicians work.

Another video post about a common medical topic. (This one with a cameo appearance at the end of a blonde who keeps following me around.)

Warfarin dosing requires viewing past values and past dosing. If every time a certain dose change results in an unwanted result, we should probably avoid making the same over- or under-correction again and again.

For many years I have used a paper(!) flowsheet that takes seconds to utilize and gives a practical overview. These sheets sit in a three ring binder. My nurse can flip through this binder and spot who is delinquent with their testing. The actual lab values are of course in the computer, but so far the three EMRs I have used can’t give me the overview I need within anything even close to a reasonable timeframe.

These two pictures say it all. My patient in the paper flowsheet has a home INR that requires weekly testing for the insurance to cover it. The “workflow” (how I dislike that word) on the bottom is from Epic.

I thought computers had the capability of speeding things up, but in my corner of the world that is mostly a pipe dream.