Provider v. Physician

Lots of discussion on twitter regarding the use of the term ‘provider’ when it is applied to physicians. As usual, there are exaggerated responses on all sides. I do believe it is a bothersome term for many reasons. It obviously was generated by some admin types as the spectrum of medical care has been industrialized and micromanaged. When looking over balance sheets it was made easier for the bean counters to lump anyone who interacts with patients into the ‘provider’ category, as they tally up where they can cut resources here and boost revenue there. Is the term as offensive to a physician as the term ‘nigger’ is to a black person, as some have implied? Or for that matter as offensive as the term ‘kike’ to a Jew, or ‘cracker’ to a southerner? Hardly, and that type of overreaction immediately prevents the argument against the term from being taken seriously. I have fortunately engaged with administrators who understand the pride doctors have in being called physicians, and realize the provider term can be at its worst insulting. I refuse to respond to those that lump me into that designation, but I will not be offended by the word. Those that apply it to physicians demonstrate their laziness and ignorance of language, but I will not rise to their bait and lose my ability to respond rationally. Do I like the term? No. But let us discuss it with reason and not hyperbole.

Medicine In America

As I tweeted the other day, things like this article are beautiful in their simplicity and directness. Kudos to Dr Elliott Martin for distilling the physician ‘burnout’ crisis down to the core elements. I have written elsewhere that the term burnout is misapplied, and a poor choice to describe what physicians are currently feeling. Although not as headline friendly as burnout, the term “physician devitalization” seems to me more accurate and descriptive. Burnout implies we are working too hard, maybe too many hours, too intense, and that some time off with a little yoga, mindfulness and herbal tea will get us back at it. Bullshit. Read Martin’s article for some of what goes on, and you’ll get a flavor for what it feels like to be a physician (not a provider). And then see how his solutions are so simple and elegant.

How To Fix The EHR

This article gained a lot of attention yesterday, summarizing the oft-told problems with the Electronic Health Record (EHR) systems in the US medical system. The article got a lot of press with some horrifying stories of how the EHR has been implicated in the propagation of medical errors, though it seems that physicians were still thrown under the bus as being part of the problem. As expected, examples of the EHR being linked to devastating mistakes included accusations that it was really doctors either pressing the wrong key or not entering the right command. Regardless, my point is that I believe EHRs actually have tremendous potential to improve healthcare, but the way they are currently used and designed is an embarrassing example of the intersection of medicine and technology. What needs to be changed to make EHRs useful? Each day this week I’ll describe something I think, if changed, could make EHRs a tool that helps both patients and physicians.

Training. I’ve used EHRs at several hospitals and in our office practice. Training is, to put it mildly, horrible. You are taught the basics to get into the system, the basics to create a progress note and enter orders, and then you are on your own. There is always a period of time where ‘helpers’ are available, but this is typically only for a week or two, and they usually do not know what physicians really want to know. Once they are gone, you are on your own. And dont even get me started on the ‘Help’ keys or links to instructional videos that are meant to provide on the job assistance as questions arise. Have you ever actually tried to use the ‘Help’ function in an EHR? You typically get some enormous data set indexed with categories that seem like they belong to a different software program entirely, and quickly you realize you’ve been taken for a fool. And the phone number that is the ‘Help Line’ to connect you with a live person? At my institution the physicians call dialing the Help Line the ‘Idiot Test’, because if you dial it looking for assistance, you are the idiot if you think you will get answers. All it gets you is a ticket number to speak with someone in another state or country who really doesn’t understand your problem and will likely suggest checking the if the computer is plugged in, turned on, etc.

Train us better. Teach us how to use it on a daily basis, on the fly, to quickly enter meaningful notes and orders to make our job easier and the patient information helpful. Give us resources that are easily accessible, so after we become comfortable with the basics we can then learn more sophisticated ways to be efficient in the practice of medicine. It always seems like we are using 5% of the EHR product, and only through luck do we occasionally stumble upon previously unknown helpful features. The EPIC videos are often actually good, but finding which one is applicable to your problem can be a nightmare.

How to Be A Good Physician

Listen. Just listen. Listen to the patient. Listen to the nurses. Listen to your peers. Listen to the voice in your head urging you to check that lab again, look at that xray again, take a second look at the patient before you leave for the day. Just listen.