tag:blogger.com,1999:blog-32053362.post4129004539695226760..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: Routine or rote?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-32053362.post-17139091966845173512012-01-20T12:43:44.933-05:002012-01-20T12:43:44.933-05:00Many years ago my daughter, a high school student ...Many years ago my daughter, a high school student at the time, had a very similar experience with repetitive questions about her pain and history while being worked up for appendicitis at a prestigious hospital in Boston in the middle of the night.<br /><br />When the intern started his questioning she asked if he could please look at the notes from the last doctor (the medical student) and give her something for the pain so she could sleep instead of going through all these questions for the 4th time again. Of course he refused and continued the questions. She was very polite until he finished, at which point she told him “YOU are a perfect example of medical waste!”Patnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82984320688774825222012-01-20T09:17:11.276-05:002012-01-20T09:17:11.276-05:00Jim, I don't know how old you are, but copying...Jim, I don't know how old you are, but copying the previous history in the chart long predates EHR's. I used to see it happen in the paper chart all the time, especially from consultants who didn't want to bother to take a history. The only obstacle was being able to read the previous doc's handwriting!<br />However, the ability of computers to 'make things disappear' IS new and truly dangerous. It's as if they never were, so paper trails of errors are very difficult to follow now.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31396855154099614642012-01-20T08:40:20.609-05:002012-01-20T08:40:20.609-05:00I understand why she was frustrated by answering t...I understand why she was frustrated by answering the same questions over and over.<br /><br />However, there is a much more dangerous trend IMCO.<br /><br />Because of the advent of EHRs, it has become much easier to simply take the history from the prior note.<br /><br />There are a lot of assumptions being made that can mislead clinicians.<br /><br />I have encountered patients wrongly carrying diagnoses of developmental delay, breast cancer and even HIV across multiple notes due to an initial error in entry that was never confirmed in later documentation.<br /><br />The copy forward feature of EHRs can also be dangerous because it will copy and paste outdated information and any changes are buried in a mess of distracting prose.<br /><br />All in all, she should be happy they actually spoke to her. The next step is getting them to speak to one another.<br /><br />BTW, when I was a chief resident, I know of at least one instance in which a third trimester pregnancy was diagnosed during a CT looking for appendicitis.Jimnoreply@blogger.com