Some examples may help you to understand why I, and many experienced physicians, am dubious about reliance on computerized medical records.
Case 1: A 16 year-old food service worker in a nursing home who underwent a periodic employment exam. During the 5 minute examination, she was found to have a tiny lump in her thyroid. A medical record indicating that the thyroid was previously normal would have been irrelevant. She was referred back to her physician, was sent to a surgeon and had her thyroid cancer cured.
Case 2: A 21 year-old male presented for a brief pre-employment physical examination. He had a lump in one testicle. A medical record indicating that his testicle was previously normal would have been irrelevant. He was referred to a urologist and had his cancerous testicle removed. He died of metasatic testicular cancer about ten years later.
Case 3: A patient in her late 40s sought medical advice for her upper respiratory infection. She previously had a mastectomy for breast cancer. She was examined that morning by her very competent Ob/Gyn doctor and no breast lump was found and the chart entry was of benign breast findings. On examination that afternoon a small breast lump was found. Several days later, her second breast was removed for cancer.
Case 4: A 25 year old male presented with an upper respiratory infection. On examining his lungs, the physician noted a grayish black mole on his back, which the patient denied ever being told of before. The following week his malignant melanoma was removed.
Case 5: A 30 year old man with Hodgkin Disease was followed with frequent visits at a university clinic. Regular reports were mailed to his primary physician. No one at the university clinic had asked the patient to remove his shoes and socks and no one observed the large malignant melanoma under his toenail. The medical record led readers to believe that the patient had been successfully treated for his malignant lymphoma, but no one looked past the chart to actually examine the patient's cancerous foot. He died of malignant melanoma, not of his well-charted Hodgkin Disease.
A physician's time spent in data entry clerical duties would be better spent in talking with and examining the patient.
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2 comments:
Dr. Kaplan,
Your interesting post seems to ignore other potential benefits from the use of computerized medical records. Your hypothesis is, in my words, that the data contained in computerized records is not indicative of the patients' current medical condition, and that doctors focusing on updating medical records would better treat their patients by performing detailed physical examinations instead of entering data. Is their any study yet to support your hypothesis?
Couldn't computerized records be helpful for patients with chronic illnesses? What about the cost savings which would free up dollars for other uses? I am talking about the elimination of the need to use valuable real estate to store paper files, and employees who must retrieve and deliver the files to doctors. And there is very real possibility that a sick patient's paper records are not complete because the physical file has not been updated.
Certainly there must be some benefits to computerized medical records that you are not acknowledging exist, are there not?
The thrust of my blog is that physician dependence on the accuracy of the medical record may be mistaken, that time spent by physicians entering data would be better spent obtaining the data through taking a suitable history and examining the patient. There is literature showing evidence that older diabetics are better cared-for by physician who do not use computerized medical records. And as for real - estate: when a doctor with a computerized medical record system leaves practice or dies, what certainty is there that the information will be as accessible (or retrievable) as a hard (paper) copy record? By the way, do you still use once-standard 5-1/4 inch or 3-1/2 inch floppy disks?
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