There are a lot of things that I will bitch about in a snarky way. But this one is serious. Don't beat the shit out of your kids. Don't shake the babies till their brains are well blended. Don't burn them with cigarettes. Don't break their helpless bones. If you do, you are an asshole. Seriously. Get some damn help.
Yes, there is a reason I am posting this. No, I can't give details. You don't want to know them anyway.
Thursday, March 28, 2013
Sunday, March 24, 2013
EMR--the real story
I have heard electronic medical records (EMRs) touted as being the "savior" of modern medicine. Supposedly, they will make sharing of records easier, reduce error and be soooo simple to use. They will also reduce costs. The federal government is strongly encouraging their use.
I call bullshit.
There are several different EMRs out there. None of them are compatible with each other. Not only that, each one is customizable; so much so that there is no way that the EMRs of two different health systems can communicate.
They differ on usability, too. My current hospital uses PITAMed*, which is one of the better ones. I find it only mildly irritating. It still takes me a lot longer to chart electronically than it did on paper. The designers of RageBuilder* must be getting kickbacks from the makers of blood pressure meds, or maybe tranquilizers. When I used that system, I had to do all my charting somewhere where no one could hear me swearing. SystemCrasher* seems to have been written by an old person who learned about computers from his 3 year old granddaughter (and let her help with the program). It was not equipped to handle the amount of data involved with hospital care. When tech support was called for the problem, they just didn't understand.
They do eliminate the physician handwriting problem, I will admit. Physicians have notoriously awful handwriting. Many of them have built-in checks for when the docs write orders, catching allergies and math errors. My fear with this is that people will get complacent, just like many people have with spell check. Just like there are errors that spell check misses, there will be errors that other computerized checking systems miss.
But make no mistake, the EMRs are not designed for patient safety. They're designed for billing. In the past, doctors decided on their own billing. Whatever the doctor marked on the sheet was sent to the insurance company. That had to stop, because some jerks made a habit of overbilling. So we now have coding/billing specialists to help us make sure that our billing matches our documentation. In some places, those specialists do all the billing work; they go over what we write and decide what to submit. In other cases, they simply review the documentation before anything is submitted, to make sure that the documentation matches the billing. That route is also perilous. When I worked at a hospital that did that, I would get messages from the billing department. "You needed one more system in your review of systems to be able to bill this level. Will you be submitting an addendum or should I bill the lower code?" Well, since you sent me this message 2 weeks after I discharged the patient, I guess you'll have to bill the lower code. If I submitted an addendum I would just be making it up-and that really IS intentional insurance fraud. It would be easy for a doctor to just do the addendum, though. The other thing that the EMRs do is prompt the doctor on what the billers need to see in the notes.
For docs who see outpatients (I don't), the EMR can be a distraction. My own doctor has to be reminded to look at me instead of the tablet he carries into the room. If I find it annoying that my PCP has his attention on a computer, and I understand why, I can only imagine how other people feel.
Eventually, EMRs may be able to do what everyone wants you to think they can. But that day is not yet here. Don't fall for the hype. And the loud swearing coming from behind that door? Ignore it. It's just your doctor, trying to do a simple note on an EMR designed by IT people with no fucking clue what medicine entails.
*obviously not the real names of the EMRs.
I call bullshit.
There are several different EMRs out there. None of them are compatible with each other. Not only that, each one is customizable; so much so that there is no way that the EMRs of two different health systems can communicate.
They differ on usability, too. My current hospital uses PITAMed*, which is one of the better ones. I find it only mildly irritating. It still takes me a lot longer to chart electronically than it did on paper. The designers of RageBuilder* must be getting kickbacks from the makers of blood pressure meds, or maybe tranquilizers. When I used that system, I had to do all my charting somewhere where no one could hear me swearing. SystemCrasher* seems to have been written by an old person who learned about computers from his 3 year old granddaughter (and let her help with the program). It was not equipped to handle the amount of data involved with hospital care. When tech support was called for the problem, they just didn't understand.
They do eliminate the physician handwriting problem, I will admit. Physicians have notoriously awful handwriting. Many of them have built-in checks for when the docs write orders, catching allergies and math errors. My fear with this is that people will get complacent, just like many people have with spell check. Just like there are errors that spell check misses, there will be errors that other computerized checking systems miss.
But make no mistake, the EMRs are not designed for patient safety. They're designed for billing. In the past, doctors decided on their own billing. Whatever the doctor marked on the sheet was sent to the insurance company. That had to stop, because some jerks made a habit of overbilling. So we now have coding/billing specialists to help us make sure that our billing matches our documentation. In some places, those specialists do all the billing work; they go over what we write and decide what to submit. In other cases, they simply review the documentation before anything is submitted, to make sure that the documentation matches the billing. That route is also perilous. When I worked at a hospital that did that, I would get messages from the billing department. "You needed one more system in your review of systems to be able to bill this level. Will you be submitting an addendum or should I bill the lower code?" Well, since you sent me this message 2 weeks after I discharged the patient, I guess you'll have to bill the lower code. If I submitted an addendum I would just be making it up-and that really IS intentional insurance fraud. It would be easy for a doctor to just do the addendum, though. The other thing that the EMRs do is prompt the doctor on what the billers need to see in the notes.
For docs who see outpatients (I don't), the EMR can be a distraction. My own doctor has to be reminded to look at me instead of the tablet he carries into the room. If I find it annoying that my PCP has his attention on a computer, and I understand why, I can only imagine how other people feel.
Eventually, EMRs may be able to do what everyone wants you to think they can. But that day is not yet here. Don't fall for the hype. And the loud swearing coming from behind that door? Ignore it. It's just your doctor, trying to do a simple note on an EMR designed by IT people with no fucking clue what medicine entails.
*obviously not the real names of the EMRs.
Thursday, March 21, 2013
National Down Syndrome Day
March 21st is National Down Syndrome Day. It's a day to celebrate acceptance of those with Down Syndrome and their varied abilities. And while we're doing that, we should work on accepting everyone who is different in ways they cannot control.
Wednesday, March 20, 2013
First day of spring?
So, today is the first day of spring. More accurately, it's the vernal equinox, when day and night are each about 12 hours long. It sure as hell isn't "spring." In many parts of the US, it's FRICKEN COLD today. I know a lot of people who would love to find that lying little groundhog.
However, the fact is that spring is (I hope) coming soon. For those of us involved in peds, that means some relief from the ocean of snot and diarrhea we've been drowning in all winter. I swear I sometimes hear the damn pulse ox alarms (signaling that a child needs more oxygen) in my sleep. We have all had enough.
However, the fact is that spring is (I hope) coming soon. For those of us involved in peds, that means some relief from the ocean of snot and diarrhea we've been drowning in all winter. I swear I sometimes hear the damn pulse ox alarms (signaling that a child needs more oxygen) in my sleep. We have all had enough.
Tuesday, March 19, 2013
I'm so shocked!
I saw this story online today. They didn't need to go through the trouble of polling parents. Any pediatrician could have told them that.
Most parents don't follow doctor's orders
Most parents don't follow doctor's orders
Monday, March 18, 2013
Trauma Drama
I read a story today about an HOA in Florida who has decided not to let kids play ball, skateboard, ride bikes, etc on the streets and parking lots in the neighborhood. The parents are all up in arms about this horrible restriction. They told the media, "I don't think they understand what it means to the kids."
No, I don't think you understand. How many drivers do you see who are texting and not watching where they're going? The outraged parents said that the kids are so good about watching out and yelling "car" for each other. Do you really think this is safe? Keep your kids out of traffic. Put doctors like me out of business and into retirement. The sooner the better.
No, I don't think you understand. How many drivers do you see who are texting and not watching where they're going? The outraged parents said that the kids are so good about watching out and yelling "car" for each other. Do you really think this is safe? Keep your kids out of traffic. Put doctors like me out of business and into retirement. The sooner the better.
Friday, March 15, 2013
Happy wheezers
Anyone who has done any work in pediatrics hears about the "happy wheezers." These are kids with viral bronchiolitis (inflammation of the small airways). They're wheezing and breathing fast, but they don't care. They aren't bothered by the problem.
I had one of these these the other day. An adorable little girl. As I examined her, she was bouncing and laughing. And wheezing like a calliope. I love it.
I had one of these these the other day. An adorable little girl. As I examined her, she was bouncing and laughing. And wheezing like a calliope. I love it.
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