U.S. CitiesCity-Data Forum Index
Go Back   City-Data Forum > General Forums > Health and Wellness
 [Register]
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
View detailed profile (Advanced) or search
site with Google Custom Search

Search Forums  (Advanced)
Reply Start New Thread
 
Old 05-05-2019, 06:09 PM
 
2,700 posts, read 959,612 times
Reputation: 3592

Advertisements

Quote:
Originally Posted by jambo101 View Post
So you think doctors should memorize all pertinant medical information on all their patients.
Unless the doc is playing video games on his computer i have no problem with the doctors i see using their computers to benefit my maladies.
I'm not sure how you got that interpretation from what I wrote. All I did was say where the electronic records requirements came from and that the only current solution out there (scribes) is a mixed bag unto itself.



I don't expect doctors to memorize anything nor am I the one who complained about their using computers during the visit. Anyone who routinely sees doctors has been dealing with this situation for years. Personally I'd rather a doctor be inputting into the computer himself than having a scribe in the room.
Reply With Quote Quick reply to this message

 
Old 05-05-2019, 07:54 PM
 
15,102 posts, read 19,511,956 times
Reputation: 21154
Quote:
Originally Posted by oldgardener View Post
Doctors used to dictate their notes at the end of the day, after seeing all the patients, and then a transcriptionist would transcribe the notes to enter in the patient charts. Apparently that's not as efficient as entering all the information directly into the chart themselves via computer during each appointment.

Not only is dictating notes not as efficient, but it can also be disturbing if the doctor does it right in front of the patient. I remember going to a cardiologist about 20 years ago -- he dictated his notes about our visit right in front of me and dictated some observations about the condition of my heart that almost gave me another heart attack right then. I found another cardiologist, who had a little more compassion, right away. Who needs that stress?
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 07:24 AM
 
266 posts, read 126,874 times
Reputation: 1059
Let's take a step back -- the massive introduction of computer into doctor's office providing patient care (I am not talking about use of computers for medical research per se, like at the NIH, etc.) was because of EMR -- electronic record keeping.

This change was mandated by the Federal Government: https://www.usfhealthonline.com/reso...cords-mandate/

Having worked in medicine for the past twenty years, with simple paper charts before and now "electronic files," I think it was a big money scam. Medical software companies swung into action in an attempt to be early and capture as much market share as possible.

As it turned out, the market is terribly fragmented. Each of the major hospital companies developed their own software. That means when surgeons go to different hospitals, they have to learn a different software for each hospital. Different softwares don't communicate between each other.

A lot of this thread has focused on computers in clinical medical practice. Let's consider a couple of aspects of that phenomena, which so irritates patients.

1) First, the medical software companies promised that medical practices could make more money by using the software, because the medical provider who charge for a more comprehensive appointment -- e.g., a 99215 is reimbursed at a higher level than a 99214. This becomes a game, where the provider has to check boxes and make selections from drop down menus to "justify" the higher reimbursement.

2) Second, IIRC, the software is "normally" rented to the medical practice. It is not a "buy it, use it" model, but a continuing evolving program and eats into the profits of the practice. The software is not inexpensive, and the more providers at the clinic using it, the greater the cost.

3) So your provider doesn't make eye contact with you as much as he/she used to? And the physician assistant is busy functioning as a scribe? Or in other cases, the doctor may train a medical assistant to be his scribe and follow him in and out of patient rooms. What is a doctor to do? He is trying to keep up with the work flow. If he sees forty patients a day, and he waits to do all the dictation at the end of the day, he may be there another hour, or two, etc.

As a physician assistant, I didn't go to physician assistant school to be a "scribe." But I would help out around the office in anyway I could.

I don't think the promise of EMR has lived up to its hype. It added lot of expenses to the practice of medicine, which was already too expensive. It depersonalizes medicine by minimizing contact and interact between the provider and the patient. I don't mean to be cynical, but color me "unimpressed."

Addendum: consider the illegal implications of EMR. We were taught in physician assistant school, "if you didn't 'write it down"/document it, it didn't happen." Providers therefore has to be meticulous in their documentation, just in case he/she is sued and end up in the witness stand. Having to document with a lawyer over your shoulder is an onerous and time-consuming task.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 08:07 AM
 
Location: Raleigh
7,923 posts, read 5,915,668 times
Reputation: 11037
Quote:
Originally Posted by oldgardener View Post
Doctors used to dictate their notes at the end of the day, after seeing all the patients, and then a transcriptionist would transcribe the notes to enter in the patient charts. Apparently that's not as efficient as entering all the information directly into the chart themselves via computer during each appointment.
I've seen Dr's that go around with a scribe that writes what the Doc tells them to.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 08:13 AM
 
Location: Houston, TX
14,235 posts, read 8,209,067 times
Reputation: 28742
Quote:
Originally Posted by Biker53 View Post
Insurance companies, hospital administrators and the feds are the ones who imposed the electronic records systems that physicians are now burdened with. The alternative to the physician inputting the data during your visit is their having a scribe in the room during your exam recording it. Some patients are uncomfortable speaking freely in front of a scribe. Some are uncomfortable having certain exams in front of a scribe, so they're not necessarily the answer either.

Welcome to the modern world of medicine.
Where did you get that idea? I worked as a scribe and I never, ever heard such a complaint. Moreover, many, if not most, doctors require an assistant in the room with them due to liability issues. However, I detested the scribe duties because I think a doctor should take their own notes. When I was assigned that task at that clinic, I was promised it would be temporary, so I did it for a while but they never reassigned it to someone else so I changed jobs. I agree the EMR is a ridiculous requirement. Despite our addiction to computers, cell phones, and apps, there are times when paper is better. And interestingly, some doctors offices also have paper charts. Strangely enough, in order to file for reimbursement with Medicaid, such claims must be mailed or faxed. They cannot be submitted electronically. I'm still scratching my head about that.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 09:10 AM
 
Location: SW Florida
9,602 posts, read 6,865,863 times
Reputation: 13825
Quote:
Originally Posted by TFW46 View Post
Not only is dictating notes not as efficient, but it can also be disturbing if the doctor does it right in front of the patient. I remember going to a cardiologist about 20 years ago -- he dictated his notes about our visit right in front of me and dictated some observations about the condition of my heart that almost gave me another heart attack right then. I found another cardiologist, who had a little more compassion, right away. Who needs that stress?
I guess this depends on one's perspective about to being informed about the reality of his/ her medical issues ( and I know we are all different in that regard) but in my recent experience with the EP cardiologist, the notes he dictated at the end of our visit were exactly what he had said to me during the visit. Not exactly what I had expected or wanted to hear ( preferring the view with my head in the sand, I guess), but I appreciate that straightforwardness and being informed of the realities that are there whether or not I face them. As well as the encouragement about managing these realities. I didn't see this straightfowardness on the part of the doc as lack of compassion at all, on the contrary, it helps to face these things and do what ya gotta do to continue to live life productively and well. I thought he showed his compassion in taking the time to show me what he was looking at, explaining the management and interventional options, and including me in the decisions about this going forward.

That's just me, anyway. But I spent eons working in the medical profession, seen the goods, bads and very ugly aspects, triumphs, tragedies, and if it's happening to me, I want to know all the whys, whats and wherefores about it. I know a number of people ( including family members and friends), who say they don't know or care about the details of their medical issues or management, wouldn't understand them anyway and just want the docs to "fix it." I can see with this type of perspective someone might not want to hear in any detail things disturbing to them about their medical issues, including in a dictation at the end of a visit.

But I appreciated seeing in writing on the copy of the visit report they gave me, exactly what the doc had told me, and the excellent documentation it provided.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 09:18 AM
 
Location: SW Florida
9,602 posts, read 6,865,863 times
Reputation: 13825
Quote:
Originally Posted by Scooby Snacks View Post
Where did you get that idea? I worked as a scribe and I never, ever heard such a complaint. Moreover, many, if not most, doctors require an assistant in the room with them due to liability issues. However, I detested the scribe duties because I think a doctor should take their own notes. When I was assigned that task at that clinic, I was promised it would be temporary, so I did it for a while but they never reassigned it to someone else so I changed jobs. I agree the EMR is a ridiculous requirement. Despite our addiction to computers, cell phones, and apps, there are times when paper is better. And interestingly, some doctors offices also have paper charts. Strangely enough, in order to file for reimbursement with Medicaid, such claims must be mailed or faxed. They cannot be submitted electronically. I'm still scratching my head about that.
You mean Medicaid will not accept electronic submissions of scanned paper records?
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 09:34 AM
 
Location: Blue Ridge Mntns., NC
10,676 posts, read 14,866,807 times
Reputation: 9427
Quote:
Originally Posted by greatblueheron View Post
Yes but some also type in their comments and recommendnoations while you sit there...can make you feel ignored.
You are absolutely right. My friend left her doctor for one that communicates via 'face time looking straight at you'. I go to the same doctor and am fed up with the no eye contract, and ... no hands on. What is the medical field coming to ? are they afraid of getting sued for something or other ? .

Don't even get me started on the cyberspace medical records. I just got one to go over it and add or delete anything not relevant and to change any items that no longer pertain. This is weird and plan to bring it up at our appt.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 09:37 AM
 
Location: Maryland
1,509 posts, read 475,623 times
Reputation: 3329
Quote:
Originally Posted by greatblueheron View Post
Yes but some also type in their comments and recommendations while you sit there...can make you feel ignored.
A number of my doctors have taken early retirement because of the onerous regulations on them. They don’t like it any more than we do, at least that’s what I hear when I can get them to talk candidly. It is what it is. Welcome to the new world I guess. Filling out the information needed while they’re with us is probably the most efficient and accurate way of doing their duty to the bureaucracy. My doctors always seem perfectly willing to talk to me about any questions I ask. It’s just the unfortunate circumstances of their jobs these days. They have my sympathy.
Reply With Quote Quick reply to this message
 
Old 05-06-2019, 09:45 AM
 
Location: Houston, TX
14,235 posts, read 8,209,067 times
Reputation: 28742
Quote:
Originally Posted by Travelassie View Post
You mean Medicaid will not accept electronic submissions of scanned paper records?
Correct. You fill the claim form out on the computer, print it out on the computer, then fax the forms you just filled out or mail the entire packet in. It is very inefficient. Now I'm just speaking of Medicaid Alaska claim forms. It may be different for other states, but in any event, it is a very inefficient system as are many government things.
Reply With Quote Quick reply to this message
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.

Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.


Reply

Quick Reply
Message:


Over $104,000 in prizes was already given out to active posters on our forum and additional giveaways are planned!

Go Back   City-Data Forum > General Forums > Health and Wellness
Follow City-Data.com founder on our Forum or

All times are GMT -6.

2005-2019, Advameg, Inc. | Please obey Forum Rules | Terms of Use and Privacy Policy

City-Data.com - Archive 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 - Top