Friday, April 29, 2016

Hsieh Forbes Column: Protect Physician Free Speech In The Office Visit

My latest Forbes column is now out: "Protect Physician Free Speech In The Office Visit".

Should politicians dictate what physicians must (or must not) say to patients when it comes to contentious political issues like abortion or gun ownership? I say, "no".

Monday, April 11, 2016

Human Stories Vs. Electronic Medical Records

Dr. Susan Koven describes how, "As hospitals go digital, human stories get left behind".

Dr. Koven described an encounter with a patient, with enormously rich detail. But when she had to record the information in the electronic medical records, the system hampered her ability to tie key connections together:
My warm feelings vanished as I sat down to document the visit. While I’ve used an electronic medical record for several years, Epic, the system my hospital recently adopted, makes recording stories such as the one my patient shared especially difficult. Her grief and her fatigue, which are inseparable in reality, Epic treats as different problems. That she lives alone and there’s conflict in her extended family, which are also inextricable from her symptoms, must be filed under a tab marked “Social Documentation.”

Epic features lists of diagnoses and template-generated descriptions of symptoms and physical examination findings. But it provides little sense of how one event led to the next, how one symptom relates to another, the emotional context in which the symptoms or events occurred, or the thought process of the physician trying to pull together individual strands of data into a coherent narrative. Epic is not well-suited to communicating a patient’s complex experience or a physician’s interpretation of that experience as it evolves over time, which is to say: Epic is not built to tell a story...

The risk of this format, as physician and medical informatics expert Dr. Robert Wachter points out in a blog post, is that we may forget that “patients are more than the sum of their problems.”

A medical record that abandons narrative in favor of a list does more than dehumanize our patients. It also hampers a clinician’s diagnostic abilities. Take a patient I saw recently, a middle-aged woman with palpitations. She was perimenopausal, stressed out at work, having trouble sleeping, drinking lots of coffee to stay awake during the day, and had a family history of heart disease. Any one of those issues might explain her palpitations, but more likely some combination of interrelated factors was causing them. Sorting out the story is crucial to deciding which tests to order and what treatment to recommend.
The electronic records may make life easier for the hospital billing department. And they may make life easier for researchers trying to do population-based studies. But if it hampers the primary care physician's ability to actually care for the patient, we have a problem.

Friday, April 8, 2016

Patient Secretly Records Surgery And Hears Disturbing Conversations

From the 4/7/2016 Washington Post: "Patient secretly recorded doctors as they operated on her. Should she be so distressed by what she heard?"

Although I don't do surgery, I do sometimes perform invasive procedures on unconscious or sedated patients.  I always speak as if the patient were fully awake and able to understand me.

One can debate the ethics of recording one's doctor when they aren't aware of it. I do fully support recording important doctor visits with the consent of both parties, as I discussed last year in, "Why You Should Record Your Doctor Visits".

Thursday, April 7, 2016

Assisted Suicide in California

News update: "Doctor-assisted dying will be legal in California from June 9th".

I recognize this is a controversial topic amongst many physicians. However, I support the basic idea in the interests of patient autonomy.

My own thoughts on this topic can be found in this January 2015 piece, "Does Your Right To Life Include The Right To Die?"