It is all about the paperwork

I just got back in the ER after pulling a postictal guy out of a car  .Once in the ER, the patient starts to have another seizure.  I order 2mg of Ativan and that quiets the seizure.  Talking with the family further, it appears that the patient was diagnosed with a seizure disorder 2 weeks ago but did not get the seizure medicine filled. SMART!!  Well, that explains why she is having the seizure.

Once we got the patient to the ER, my first thought was “Man, I better go and start the patient’s note.” I did not want to get behind on paperwork.  In medicine, the chart and the paperwork is everything.  It is what saves you when you get sued, it is what the rest of the hospital uses to see what happened, but most importantly (at least to the hospital) the note is what is used to get paid.  Because of all this, there is a tremendous pressure to get your notes done.  A lot of times, the importance of the note takes priority over treating the patient at least in the administrations eyes. Due to this, it comes down on the pit doc.  Stabilize the patient and then get your note done and make sure you word it in a way that the hospital can optimize billing.  It is crazy that I can see and care for a patient in less time than it will take me to complete the note about this same patient.  This electronic health record thing just makes this time longer.  EHR was supposed to be the cure all.  Instead it is a disease in and of itself.  Paper is much faster with less typos.  This is coming from the most computer savvy doc in our ER – me.  And this is at the government hospital where time and through put does not matter.  No one at Uncle Sam General cares about speed and how fast things are done.  Think about how much worse it is at the private hospital where each patient is more money for the hospital.  The private hospital is all about seeing more and document while still trying to provide “quality” care.   How many emails do I get from the private hospital about the care I provide to my patients – NONE.  But I get at least 1 email for every chart that I have not completed at the end of my shift.  Why is this? Because for every incomplete chart, the hospital looses money.  They do not care that I might have been busy all day caring for sick patients or spending a little extra time with a family explaining a diagnosis.  In the end, “Forget the patient, it is all about the paperwork!”


2 comments on “It is all about the paperwork

  1. Hi, Jonathan – I’m really glad you started this project and I’ll be following it so I can review your posts in my WP reader. I’m teaching at a residency program right now and am really interested to hear your take on priorities, systems, levels of care, nuances, etc. within the world of medicine. See ya, KR

  2. Kay says:

    I agree completely. The record take 14 minutes to do a simple sore throat. The computer is turning us into robot medicine.

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