E-bola, E-MR, E-gad!

E-bola, E-MR, E-gad!


Leonard Zwelling

         If there was one take home lesson from my time in DC, it was
how many different groups of people wanted to tell me how doctors should
practice medicine. Interestingly, none of these people were doctors themselves
and some were so young that the last doctor they saw was a pediatrician if not
a forceps-bearing obstetrician. Health economists, public health officials,
senators, congressman, lobbyists, think tankers and hordes of staffers all had
brilliant ideas about how to care for sick people in a more efficient and
cost-effective manner. Frankly, as my late, great world-class pathologist father-in-law
liked to say to me, “what did they know?”

         One of these great innovations about which I heard so much
during my year on the Hill was the revolutionary effect electronic medical
records would have on the care of patients. The EMRs would save money, minimize
errors, and streamline care. If you believed all of that, shame on you. It’s
not that I am against the EMR. I am not. I just never saw how it would save any
money and at best might be a way to reduce errors by assisting decision making
by allowing instant access to both patient information, comparative
effectiveness data, and the medical literature. Well, it was a rational
thought, right?

         Flash forward to last week in Dallas where a patient came
into the emergency room at Texas Presbyterian Hospital with fever, headache and
abdominal pain. A nurse asks whether or not he had recently traveled to Africa.
Yes, came back the honest answer, which was more than can be said for his
answer in Africa when asked if he had come in contact with a sick person. As
has been widely reported, he assisted in the attempted transport of a pregnant
woman with Ebola virus who was turned away from four centers and died within hours
of his last contact with her. He left that part out. But he did not leave out
the part about being in Africa. From what I can tell this was duly entered into
the EMR.

happened after that is unclear, but somehow the doctors that cared for the patient
did not re-ask the travel question or ignored (or couldn’t see) the answer
previously given and the patient was released from the ER only to return with
Ebola In Flagrante two days later having been in contact with a number of
others by then including children. This cannot be considered a victory for his
doctors, his honesty or the EMR.

again it illustrates what good doctors really do. They interact with other humans in
an attempt to use their special skills and knowledge to alleviate human
suffering. Having now been a patient cared for by a doc using an EMR, I suspect
my chart might look better than I do, because that laptop was far more a focus
of the physician caring for me than I was. (I don’t see that doctor any more.) The
same may well have happened in Dallas with disastrous consequences for the
patient, and perhaps, for others.

(and I know I sound like a scold and a fuddy-duddy), I prefer my doctors
talking to me rather than to a screen.  I
will take a doctor’s clinical judgment over a machine’s algorithms any time,
but I shouldn’t have to choose and I wouldn’t if there were time for both. But
apparently there is not (every 15 minutes for a new patient, doc. Hurry up says
the chief operating officer), so the machine wins because the machine is linked
to the billing system and the doctor has been reduced to a fixed coast burden.

just say for me, when this Ebola thing ends (and it will shortly, I believe),
and the scorpions that run the news business move onto something else, we still
have a lesion in the system if we think the EMR is a substitute for a human
physician or other caregiver. (I think “providers” use EMRs, but I could be
wrong. Doctors use their heads.)

goodness sake, if the doctor did not ask the patient face-to-face whether or
not he had been to Africa in light of what is happening there, shame on the
doctor. Don’t blame the nurse and don’t blame the EMR. The buck stops with us,
as it should and not with the administrators selecting these computerized
systems that putatively are good for us, but may not be so good for the patient. 

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