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    Your Voice: Physicians need to take back the medical profession from EHRs

    believe that it is high time that medical doctors (not “providers”) rise up and regain our rightful and long-lost place at the top of the medical hierarchy. How in the world did this happen in the first place? How did we become second-class citizens, led around by the nose and pushed around by those with half of our education, intelligence, and dedication?

    In most cases, administrators with a four-year-degree can fire a doctor with 11 to 15 years of training. But how many times has anyone heard of a doctor firing an administrator?

    Almost none of the “innovations” happening in medicine these days come from doctors, they all come from bureaucrats and non-physician managers. They all come from outsiders who now know best. Doctors have become whipped dogs waiting passively for the next group of bureaucrats to rain down the next mumbo-jumbo solution from on high.

    There now is a huge emphasis on measuring the “quality” of medical care and to improve “outcomes.” I believe it is impossible to judge the quality of medical care by looking only at discreet, retrievable data points generated by an EHR. Quality happens behind the closed door of the exam room and can only be judged by another physician. Bureaucrats and admins are clueless to the true nature of quality care.

    Quality starts with a relaxed, unhurried atmosphere where the doctor asks the patient about their concerns, takes a thorough history and performs an adequate physical exam. He then uses his experience and vast knowledge of anatomy, biochemistry, physiology, and pathophysiology and interprets appropriate studies to arrive at the correct diagnosis. He then must decide on the best medications, treatments, and follow-up plans. If done correctly, this all takes a good deal of time, much of which has now been stolen from us by the data-entry, box-clicking, and typing demands of the EHR.

    Next: "Delivered care with compasion and respect"

    11 Comments

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    • [email protected]
      Dr Sanchez, you have it exactly right. We love DPC. We cut our overhead by 60%, and still make a great income. It is real medicine affording time with each and every patient to diagnose, educate, support, and advise just like we were taught! Our major problem was giving away all 30 waiting room chairs to churches and clinics because no one waits anymore! Patients and staff love it because we stay right on time, but give them all the time they need. I would welcome a call or email at anytime. Many of our colleagues are horribly distraught and are under suppressive contracts. They are fearful of speaking out and jeopardizing their living. There is a movement called noncompetes.org which is gaining momentum to break professional contracts. Many states have laws prohibiting doctor noncompetes and restrictive covenants. Indiana legislature introduced HB 1235 this year, but it was tabled in committee by lobbying groups from hospitals and insurance companies. Interesting there is one profession that has noncompete laws in every state, that's right , the attorneys. There is freedom and light in this mess and it is called DPC. Anyone, call or email me anytime, because time is what I own now! [email protected]
    • [email protected]
      Amen and can I get a rousing BOO-yah from the audience? We DOCTORS (and I mean MDs and DOs, no one else) quite frankly abdicated our position at the top of the health-care hierarchy the minute we allowed ourselves to be call "providers". Although we may never regain that role. I still correct everyone in all interactions, written or otherwise, that I'm a DOCTOR. Anyone with a few hours of training can call themselves a provider, but only those with our level of education, training, experience and sacrifice are DOCTORS. We need to remind the suits, the administrators, the "leadership" (BIG air-quotes here) whose work brings in the money to pay THEIR salary. When I still worked for the local healthcare behemoth, I had NO problem reminding the suits whose work paid for their salaries, and I promise you it wasn't the work of the spreadsheet and PowerPoint crowd. I'd tell them they can have medicine that is GOOD, FAST or CHEAP, pick two. More of us need to have that chip on our shoulders (firmly and with temperate language, but still with a chip). If the PowerPoint propeller-heads want all the boxes for cookbook medicine checked, let them hire the health-informatics people to read our dictated SOAP note essays and extract the data; that's what coders and billers are trained to do. Leave us DOCTORS the hell alone to do what we were trained to do: get people well, one patient at a time.
    • Anonymous
      Excellent. Totally agree!
    • [email protected]
      Well said, Dr Johnson. We have sold ourselves out entirely to corporate medicine and government bureaucrats. I am afraid there is no reversal for traditional medicine. After 36 years, my partners and I had had enough. Burnout and disgust for the system greeted us everyday as we jumped on another treadmill of 30 plus patients daily. But, we loved medicine and our patients who appreciated us in return. So, Direct Primary Care became our war cry. We love it. Now we see 10 or 12 patients daily, take all the time we need, call patients back, and even have time to make wonderful old fashioned house calls! We are free from insurance and government regulations and reports. We are out of networks, we do not bill, and we do not work for the insurance companies any longer. We work for our patients. We generate statements and show patients how to fill out and mail, including Medicare using form 1490s. Their reimbursement is sent to them. No billing, no collections, and real medicine that we trained for and love. A piece of heaven in Indiana is making medicine enjoyable again. Stop and smell the roses my colleagues. Dr Bob 3178671236 ,[email protected]
    • [email protected]
      Sir, you are my role-model. I am at the point where my little micropractice is DONE being the insurance companies' b***h . . .and ready to make the scary jump into direct primary care. May I email or call you for guidance?
    • [email protected]
      The EMRs are only a part of the problem. Our professional societies and the AMA have bought in to corporate medicine. The majority of an EMR note is worthless stuff that no one reads - only there to satisfy some Joint Commission requirement, or a coder requirement (such as the complete review of systems documented in each note) or a payor requirement. Our professional societies need to tell CMS to get rid of MACRA and MIPS and every other alphabetic mandate that is placed on us - and then tell the ABMS to get rid of MOC. Let us keep up to date on medical care - not coding, not billing, not metrics. All the time that we have to learn some mandate from above, and all the time spent on the EMR documenting worthless stuff (such as the learning needs assessment, falls risk documentation, cultural barriers to care, etc.)is time taken away from either our patients, our families, or keeping up with the medical literature.
    • Anonymous
      Dr. Johnson, I concur on your main point: EHRs need to improve. They are, however, here to stay. I take exception with some of your other points. 1. Almost half of “providers” these days are not MDs. They also have to deal with EHRs. 2. Doctors are often considered arrogant. I wonder why. I have known many intelligent administrators, and many very ignorant physicians. 3. The people who are paying you, the third party payers, have reasons for making sure that the care their customers (our patients) receive is both high quality and high value. There are measurable outcomes for both. As someone who cares about health care quality and cost/value, I support their efforts. We should all care, since medical care is chewing up 18% of our GDP with arguably mediocre societal health. 4. Doctors are now reaping what they have sown. Doctors have done what they wanted, regardless of cost, and often in ways that helped them pay for their second homes. The time of reckoning has begun in this time of easy data.
    • [email protected]
      Well said. Our 4 board-certified family physicians have yet to find an EHR program that doesn’t do exactly what you have railed against. We are not computer phobic and use computers in our lives daily. We do electronic prescribing and completed meaningful use stage 2. We are a level 2 PCMH. But the current MIPS requirements are going to end up creating a situation where we cease trying to comply with the EHR evolution as, despite an exhaustive search, we have yet to find an EHR system that “works for us.” For now we’ll stay with our reliable and efficient paper chart system with continued readable dictated progress notes until such a system is developed. One that doesn’t break the bank. I’ve said all along that I need a 10th generation EHR product, and I’m not sure we’re past the 3rd or so yet.
    • [email protected]
      I have only used one EMR since I left employed medicine and it works beautifully. I create my own templates and dictate what is essentially a SOAP note, with only limited box-checking. It was created by a family doc and the inherent user-friendliness shows. One technophobic colleague tried it, wasn't completely happy and transitioned to another EMR...that he absolutely detests. He regrets the change away from the original EMR. Just sayin'
    • UBM User
      Hello, History shows agricultural productivity went up when barbed wire came into use to control cattle activity. Corporations now exist to provide "control" solutions to the remaining "troubling" behavior of the recalcitrant physicians. The older physicians were easy enough to control by money (3% of their medicare reimbursements and $50K reimbursement for EMR installation, etc) and the younger now seem to be selected and trained for their "herding" instincts and therefore more easily managed. Once you buy in, i.e. ACO structures, what you do and how you do it can be tightly controlled through EMR monitoring. So how did this happen? It is just a matter of $Money$ and who gets to keep it. The rest is smoke. Move along folks. Move along. Nothing to see here.....

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