Physicians

Please Choose One

flying cadeuciiPlease choose one:

The three words blink in front of me on the computer screen.

Please choose one:
Patient is-

Male     Female 

I click FEMALE.

I watch as the auto-template feature fills in the paragraph for me based on my choices.

Patient #879302045

Patient is: 38-year-old female status post motor vehicle accident. Please acknowledge you have reviewed her allergies, medications, and past medical history.

I click YES.

Have you counseled her about smoking cessation?

I click NO.

A little animated icon of a doctor pops up on the screen. His mouth begins to move as if speaking. A speech bubble from a comic strip appears next to it.

“Tip of the day: smoking cessation is important for both the patient’s health and part of a complete billing record.”

The animated doctor smiles and swings his stethoscope like a lasso.

I click ACKNOWLEDGE.

A new screen appears.

Please choose one:
The patient’s current emotional state is best described as-
☐ Distraught     Calm      Agitated

I turn away from the computer to look at the patient. She lies curled in a ball on her side. Her bare feet stick out below the sheets halfway off the gurney. I notice she has a turquoise blue toe ring. She stares straight ahead. She plays with her patient ID band, twisting it round and round with her other hand. Makeup is smeared around small brown eyes. She stares blankly at the wall behind me. I clear my throat. She doesn’t blink. I clear it louder. Still nothing.

I look back to the computer. The same screen is still there.

Please choose one:
The patient’s current emotional state is best described as- 
☐ Distraught     Calm      Agitated

I turn back around.

Blonde hair is matted to the right side of her face where tears have dried it to her skin. A thick strand of it hangs across her eyes and I wonder if it annoys her. I watch as tears reform in her eyes and run sideways across her face. A teardrop starts to grow on the side of her cheek. More tears are added until finally it falls from her face onto her tear soaked pillow.

Her chest rises and falls at a rapid pace. She is breathing fast, almost panting. It is a raspy sound. I bet if she spoke right now her voice would sound raw, the kind of scratchy raw that comes after too much screaming. But she doesn’t speak. She just lies there breathing with a thousand yard stare fixed to her face.

The computer dings.

Please choose one.

I click DISTRAUGHT.

The computer takes me to a new screen.

Please choose one:
Patient’s primary reason for being distraught-
Emotional     Physical     Other

The patient starts moaning. I look over. A guttural sound that is part wail, part cry spills out of her just loud enough for me to hear.

I click EMOTIONAL.

That selection triggers a new screen for me with new choices:

Please choose one:
What is the reason for patient’s emotional problem?
Intoxication   ☐Psychiatric   ☐Neurologic

Hmm, I look at her trying to decide which to choose. She is in a hospital gown. Her clothes were cut off with the trauma shears when she came in. She still smells like gasoline and blood and burnt plastic smoke. It burns my nose sitting this close to her and makes my eyes water.

There’s dried blood mixed with car oil and dirt on her chest. There is a lot of it. It covers her shoulders and the top of her breasts like a red patchy shawl, yet she is not injured. She has been examined and x-rayed and CAT scanned from head to toe. Her body is fine.

The computer dings again impatiently, prompting me to choose one.

Please choose one:
What is the reason for patient’s emotional problem?
Intoxication   ☐Psychiatric   ☐Neurologic

I click the Next arrow at the bottom of the screen to try and advance the page without choosing one.

PAGE INCOMPLETE- YOU MUST CHOOSE ONE pops up.

My mouse circles the screen hesitantly. I guess I will click… PSYCHIATRIC. In a way emotions are psychiatric, I tell myself.

Choosing psychiatric has opened a new screen.

The patient shifts on the bed. A glimmer on her head, reflecting the fluorescent lights above, attracts my attention. I lean in closer. There are shards of broken up windshield glass scattered throughout her hair. Some are brown from dirt from where she lay on the ground, some are stuck to her head from blood, and some are scattered on the sheet below her. The shards twinkle on the bed like little stars.

I frown, the nurse was supposed to clean her up. I wheel backwards on my doctor stool across the trauma room to the door. I lean my head out through the curtain.

I look around. I spot the patient’s nurse. She is sitting on the other side of the ER, working at a computer. I know she is trying to enter data from the patient’s visit to get her charting done. Well, I think, maybe someone else can help us.

I scan the ER. There are doctors and nurses everywhere down here, yet every single one that I see sits at a computer with their eyes chained to the screens and a scowl on their faces while they click and type, click and type. I bet the hospital could burn down around them and they wouldn’t notice.

“Hey!” I yell.

No one even looks up. The clicking and typing continue.

An old man standing in the doorway of another patient room makes eye contact with me. He scowls as he surveys our ER. He shakes his head in disgust. I blush and duck back into the room behind the curtain.

The computer dings twice now, prompting me to hurry up. I remember my patient throughput time is monitored and reported and compared to the national average. A timer has appeared on the bottom of the screen, letting me know that I am four minutes twenty-eight seconds past the average ER doctor throughput time.

The numbers keep climbing. If I spend too much time on one patient, I will get a letter from administration for not meeting my throughput quota. I wheel back up to the computer.

Please choose one:
Because you chose Psychiatric, patient was offered-
Counseling     ☐Medications     ☐Inpatient Care

A sob wracks my patient’s body interrupting me again. She shifts in the bed, leaving clumps of brown dirt crumbling on white sheets. She is absolutely filthy. I wonder how long she lay in that field before someone found her. She still stares at the wall, unresponsive.

I look back at the computer. I didn’t offer her any of these things. Maybe I should lie and click counseling so that I can finish her chart.

I click Next.

YOU MUST CHOOSE ONE pops up again.

Please choose one:
Because you chose Psychiatric, patient was offered-
Counseling    ☐Medications   ☐Inpatient Services

I try alt tab. No luck.

YOU MUST CHOOSE ONE.

I give up and click COUNSELING.

Another screen.

Please choose one:
Patient responded to counseling with:
Excellent Improvement Some Improvement No Improvement

I click NO IMPROVEMENT.

The little doctor figure reappears on the screen. He’s holding up his index finger and a light bulb appears over his head as if he’s just had a fantastic idea he can’t wait to share with me.

“Dr. Tom Tip reminds you: Did you try offering a drink of water or a tissue? Surveys show that sometimes it’s the little things that make patients feel better.”

I look over at her. I can’t bring myself to offer her water. Her knuckles are blanched white from the death grip she has on the side rail. She’s mouthing the word NO over and over to herself and shaking her head back and forth. Her eyes are wide with terror and do not see me. The skin of her face is pulled taut with fear.

I know that look. She is seeing the moment. I know she is going to see it again and again for the rest of her life. It will come in nightmares, it will come in dreams, it will come at the worst possible moment of what should be happy occasions, more likely than not it will even come at the moment just before her own death no matter how long she lives. She will never escape it. Sixty-eight minutes ago her brain burned an image into the inside of her skull that she will never be able to unsee.

I click SKIP.

The doctor icon disappears, replaced by text.

Please choose one:
Did you offer the patient water?
Yes     No

I click NO.

The little figure pops up again this time with a stern look on his face and his arms crossed.

“Surveys show patients like it when their doctors offer them water or a tissue. Patient satisfaction scores go up. Try it, you might be surprised.” He uncrosses his arms and holds out a little of glass of water.

For a brief second I imagine punching my fist through the computer screen. It would feel so good to climb the stairs to the top floor of the hospital with the computer stuck on my arm. I imagine spinning in a circle and launching it as hard as I can off the roof of the hospital towards the pavement below. I would give anything to see it smashed and destroyed and ruined, just as it has done to this profession I once loved.

But I know they would just replace it with another computer and just as quickly with another doctor.

I sigh and look around the room.

There is a cup on the counter.

I frown, it is awfully dirty.

I pick it up and turn it over.

A child’s tiny, bloody shoe falls out onto the counter.

The woman cries out, Oh God Oh God Oh God and grabs the child’s shoe before I can pick it up.

She holds it next to her face. She’s sobbing now and starting to scream. Oh God Oh God Oh God Oh God Oh God. She clenches the shoe to her chest. The blood on the shoe matches the blood on her chest.

The computer dings.

“Did you give the patient a cup of water?”

I lie and click YES.

“Good job!” The computer trumpets out a happy horn sound. It’s hard to hear over the patient’s screaming. The little doctor gives me a thumbs up and high fives a hand that appears on the screen next to him.

“Sometimes it’s the little things that make people feel better.” The doctor says.

I click NEXT.

The Patient Disposition Screen loads.

Please choose one:
Where is the patient going after the ER?
Home     ☐Admitted     ☐Transferred

I hover the mouse on the screen for a second, trying to decide.

I click HOME.

Please choose one:
How is the patient doing after your care for her?
Improved      ☐Not Improved     ☐Other

I look at her again.

I click NOT IMPROVED.

*WARNING*

This time the whole screen flashes. The little doctor is back, hands on his hips. His face is stern as the speech bubble appears next to his head. The letters are in red this time.

“Patients who are NOT improved should NOT be sent home. You clicked Psychiatric as her primary issue. Perhaps some medications would help the Healthcare Consumer. Would you like me to recommend some choices available on the hospital formulary?”

I ponder the question. Is there a drug for this? Something that will make her feel better? Something that doesn’t wear off like, ever?

I click NO.

Are you sure? The computer asks again.

I click YES.

A big red flag now pops up on screen and the computer buzzes like a half time buzzer in a sports game that I have just lost.

A note of this patient encounter has been sent to your Hospital Administrator for chart review of this patient. It is the goal of our healthcare facility to make patients feel better before they are discharged. You have acknowledged that you failed to do so. You will likely receive a lower patient satisfaction score for this.

Please acknowledge.

I click NO.

It flashes again.

Please acknowledge.

I click NO.

Please acknowledge.

I click NO.

A box pops up.

I am sorry, Valued Healthcare Provider, do you not understand the question? Would you like to fill out a service ticket?

Yes   No

Please choose one.

The words blink at me on the screen.

I look over at the patient. She is on her side again, sobbing as she cradles the tiny shoe to her chest. Her eyes are squeezed shut and she’s rocking back and forth so hard the whole gurney is shaking.

I look back at the computer.

Please choose one.

I look back at my patient.

Please choose one.

Suddenly I get it. I choose.

I reach down and unplug the computer. The screen goes black.

Without the noise of the computer fan whirring, the room is suddenly silent- save for her quiet sobs.

A strange feeling comes over me, one I almost forgot existed after so many years.

I remember who I am and why I am here.

I stand up and take a deep breath. I step towards the patient and begin the long and tedious process of gently picking out the shards of bloody glass stuck throughout her hair. As I start to work she opens her eyes and blinks.

She sees me.

The terror filling them fades just a tiny bit.

For once the computer stays quiet.

I pick through the strands of her hair. The three words blink in my mind over and over.

Please choose one…

Please choose one…

Please choose one…

 

The author is an ER physician practicing in Walla Walla, Washington.

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ak7000Ms. LibertychrisOhi OhiozeVipin Pandey Recent comment authors
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ak7000
Member
Ms. Liberty
Guest
Ms. Liberty

Well, I see the haters and the racists are here today in force spewing the venom they have been commanded to repeat by Rush Limbaugh and Glenn Beck.

chris
Guest

I am afraid this satire is not really far from the reality..Healthcare system evolution is probably following this trend which probably tries to comply both with ever complex regulations and cost control by using machines instead….

Ohi Ohioze
Guest

Hilarious!!! I do hope healthcare never comes to this;having computers tell us what to do.

Vipin Pandey
Guest

Great story, telling the waiting time in a hospital. You take right decision to unplug the power cable.

Bernard Farrell
Guest

This sounds like a nightmarish system. That it takes valuable time away from interacting with the patient is unacceptable. Sorry you have to suffer with it.

Kimberly Jones
Guest
Kimberly Jones

I was urged to read this by a doctor here in Centralia. I remember Dr. Green, and his compassion in our ER here. This has brought tears to my eyes. I love the fact that you unplugged and showed compassion! The human factors are starting to be replaced! We need more Physicians who are willing to take a stand for what is right! EHR is great but should NEVER be allowed to be any more tgan a record! A physician should not be overridden or pushed through by any program! We are NOT parts on an assembly line, we are… Read more »

Doctor 999
Guest
Doctor 999

crickets

Doctor 999
Guest
Doctor 999

Peter1 says: He is being sarcastic- great- but please note which statements(assuming all are) are sarcasm because EMRs were based only on billing at the last five places I have used one (admittedly only hospitals) My car my phone my camera and my lap top WASTE at least an hour a day more than the ones they replaced, I OFTEN go back to the old ones(not the camera or laptop) when I need to get something accomplished quickly precisely because of the “improvements”- thankfully the old car phone and desktop are usable, though in need of repair I take twice… Read more »

Peter1
Guest
Peter1

Doc999, who is your beef with? Our modern society and the industrial medical complex or me? I don’t own a cell phone. My wife uses an old non-contract Tracfone for outgoing only. We replace only when absolutely necessary and not when the hype tries to convince us our life will be better with more complicated, less quality, planned obsolescence stuff. I fix my own 10+ year old cars and computer. I stay away from doctors and especially hospitals until I’m on deaths bed. We’d all be better with less doctors – retired out. BUT, I’m not a hospital or running… Read more »

allan .
Guest
allan .

“I stay away from doctors and especially hospitals until I’m on deaths bed. We’d all be better with less doctors”

Then most certainly you must hate the ACA. It promotes doctoring where doctoring doesn’t do much good. Ex: Useless preventative care benefits, the promotion of excessive doctor and hi tech use, etc.

You sound right up my alley. Many complain that we have too few doctors and I keep wondering if we have too many.

Peter1
Guest
Peter1

allan, the ACA doesn’t promote anything more than the system did/does without the ACA. The ACA IS the system, as it uses the private insurance and health care system we all love and hate to provide access to people who did not have access before, through subsidies that were only available to the very poor and the middle/upper class prior to ACA.

I don’t like the ACA because it does not tackle costs. But I imagine that if it did you’d rail against it for that because it imposed restrictions on private business and citizens.

allan .
Guest
allan .

What are you talking about? There are now mandates for preventative care and most of that is useless.

Take note there is a difference between a free marketplace as envisioned by Adam Smith and the socialism some prefer. We have seen the marketplace far exceed the socialists and communists. Even the communist Chinese have learned about the benefits of the marketplace and we have seen their economy grow.

Peter1
Guest
Peter1

“Insured American women get more of both”

So even before ACA insured American women got more of both. Good, now formally uninsured women get the same access unimpeded by cost.

Now we can discuss what number is appropriate for everybody to bring down costs.

Allan
Guest
Allan

You are a bit mixed up in your response Peter1. The ACA didn’t have to tell women in the US to get their Paps and Mammograms. But, the left loves to tell others what to do whether they need it or not. This comparison of who gets what exists in other parts of the healthcare debate as well. But, outcomes tell the story. The well respected CONCORD cancer study gives Canada good marks though they are not at the top if all the study results are averaged together. I think Canada provides good care none the less. The US is… Read more »

Peter1
Guest
Peter1
allan
Guest
allan

Peter1, what are you trying to demonstrate by sending us to this site? “
Affordable Care Act Rules on Expanding Access to Preventive Services for Women”

Let’s take mammograms and pap smears the most commonly discussed ‘preventative’ care for women. Insured American women get more of both than the insured Canadian woman! In fact when it comes to the uninsured American woman she gets the same number of tests as Canadian women.

Were you trying to demonstrate that Canada needs the ACA to improve their preventative services?

Peter1
Guest
Peter1

“the left loves to tell others what to do whether they need it or not.”

Not telling anyone what to do, but if they think they need to get something looked at, cost won’t interfere with the decision. Women are free to not get tested.

“Canada ranks near the top where woman are concerned.”

Not bad for a flaming socialist country that tells others what to do. :>)

At half the cost BTW.

allan
Guest
allan

“Not telling anyone what to do, but if they think they need to get something looked at, cost won’t interfere with the decision” You are not telling a woman to be tested, but you are telling someone else they must pay for it. Canada provides reasonable care. I leave it up to Canadians to determine what they want to do and what is in their nature. I want Americans to decide what they want to do with full knowledge of what they are getting into. You said you are not “telling anyone what to do”, but I hear quite the… Read more »

Peter1
Guest
Peter1

allan, as a Canadian and non-voting U.S. resident, who pays taxes just like you, I am also being “told” I must pay for it. Not just for ACA but for everything else “Americans” have determined who pays and who receives. I’m not happy with a lot of my tax subsidies, especially to successful and wealthy corporations and individuals. But I’m just part of the discussion, like you, but with no power to “tell” as I can’t vote. The problem I’ve found with many American attitudes such as yours is they think they know the ultimate truth and can do it… Read more »

Allan
Guest
Allan

“The problem I’ve found with many American attitudes such as yours is they think they know the ultimate truth and can do it better than anybody else, while not be accepting that there might be a another way.” Quite the opposite. You want to dictate, mandate, coerce etc. to get your way. That is the problem with your type of ideology. I want to do none of those things. I want a marketplace where people vote with their dollars. “I think it comes from the insulation America has been able to enjoy because of geography and economic power.” It comes… Read more »

allan
Guest
allan

Peter1, I thought you might be interested in another article on health status between Canada and the US that is from the NBER. I don’t attach too much emphasis on any one study, but there are others that indicate the same things. I also believe that all countries have a lot of warts in their respective healthcare systems and have different needs so I don’t fault Canada for it is a different country than the US. The abstract is as follows: “Does Canada’s publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably… Read more »

Peter1
Guest
Peter1

allan, I’m not sure if you read the whole paper or what you draw from it. I know that concerning wait times, Canada is probably doing better now than in 2007 as it appointed a commission to address the issue and established wait time targets and reporting as well as expending more money. But the paper made a very significant point: “One important issue that we do not address concerns the large differential in per capita health care expenditures which are about twice as large in the U.S. Is the U.S. getting sufficient additional benefits to justify these greater expenditures… Read more »

allan
Guest
allan

“allan, I’m not sure if you read the whole paper or what you draw from it.” The paper helps one learn how to evaluate things. I didn’t intend to demonstrate that the US is better than Canada for I have already told you that different countries need different things and I leave it up to the citizens of the various nations to decide what is best for them. You seem a bit defensive because immediately you jumped to the one item the study demonstrated the US clearly has fallen behind in, cost. It’s true, but the cause is not the… Read more »

Peter1
Guest
Peter1

“according to the Quebec courts is inhumane treatment of Canadian patients when they ruled against the government. I am sure many Canadians in need of quicker care say thank God for that decision in Quebec because without it They would be waiting even longer.” allan, that Quebec Supreme Court decision is years old now. But if you’re interested in the outcome, after that decision Quebecers were allowed to buy private insurance, the result was that not one policy was purchased. So, for a vast majority of Quebecers it was a non-issue. As an addition to Ca v US I just… Read more »

allan
Guest
allan

“it was a non-issue.” That is fine. The people were given a choice so those that didn’t want people moving toward the alternate choice made things better. Choice doesn’t necessarily mean something new. Sometimes all it does is make those in control do more of what the people need and want in order to keep in control. The Quebec decision calling the specific Canadian waiting times inhumane was a total success based upon what you are telling me. Some Canadians tell me another Quebec decision would improve care even more. “Dr. Welch’s research has focused on the problems created by… Read more »

Paul Slobodian
Guest

Peter1,

I think perhaps you are right…..they did want standardization (among other things)…..but it hasn’t worked out very well (predictably if you ask me).

Standardization doesn’t work well when it is govt bureaucrat defined and driven.

Paul

Peter1
Guest
Peter1

“Standardization doesn’t work well when it is govt bureaucrat defined and driven.” I think you’re letting your distrust for anything “government” obscure reality. Energy conservation standards, food safety standards, and all sorts of appliance safety standards including automobiles and airplanes. As to your cell phone example what if government enacted tower sharing regulations, do you think we’d have less visually obtrusive towers at less cost and better geographic coverage, then let the cell providers compete on service and price. An oversimplification, but all government had to do for EHR was say there has to be complete interoperability, then let the… Read more »

Paul Slobodian
Guest

Saburabh, You may well know more than I do, but I don’t think standardization was the goal….if it were I don’t think there would be so many problems with “interoperability” amongst ehr systems now…so many years after the mandates/inducements/penalties were introduced. And, standardization is best left to the “bottom up” designers….they make it happen when it is needed by the market….i.e. my iphone interfaces just find with my android phone friends and with my computer and with just about every website on the planet. If top down govt entities define the standardization it most surely will be a mess. In… Read more »

Peter1
Guest
Peter1

“I don’t think standardization was the goal….if it were I don’t think there would be so many problems with “interoperability” amongst ehr systems now…so many years after the mandates/inducements/penalties were introduced.”

“And, standardization is best left to the “bottom up” designers….they make it happen when it is needed by the market”

Trying to connect those two opposite statements. Yes, standardization would have been good, no we don’t need standardization – because the market hasn’t required it yet. Which market hasn’t required it if you think it would have been good?

Paul Slobodian
Guest

Peter1 The govt. is telling you to buy a system or face penalties…..and the default is Epic. I might have changed my cell phone example to simply saying the govt was requiring/inducing everyone to buy a cell phone….the default would have been Motorola Startac. It doesn’t change the analysis. Once the govt. mandates/inducements are removed each buyer decides when the benefit of buying outweighs the costs. That is how computers, cellphones, automobiles developed….and the systems get better and better (not perfection…just great value over time). Competition and propriety software are essential to the process, or we end up with the… Read more »

Saurabh Jha
Guest
Saurabh Jha

It’s an interesting analogy with other technologies.

Would a bottom up approach resulted in a better EHR? Arguably, yes, given its track record in other technologies.

But the aim of EHR was rather different. It wasn’t so much to achieve effficiency as to achieve standardization.

If standardization is the goal, then it should not surprise anyone that standardization will be the means.

allan .
Guest
allan .

“Would a bottom up approach resulted in a better EHR?” Saurabh, I don’t know if you were on the scene when computers first started to be used in physician offices. I remember my first ‘EHR’ in the mid 1980’s that I was able to access by phone. Being 1/1 I didn’t have the funds available to permit me to adequately link up with my lab and the hospital. My lab, dealing with thousands, did have those funds and was willing to pay some of the costs. The Stark Laws prevented this from being satisfactorily done. That is about 30 years… Read more »

Paul Slobodian
Guest

Peter1, re your comments: “Saurabh, have all the electronic devices and systems in your life made it more complicated or less? Do you have so much more free time now than before electronics?” “Proprietary software and competition actually hinder better HIT.” Yes, our electronic devices are wonderful tools that enhance our lives…..and HIT/EMR technology might become great tools in the future. The problem is that they are being adopted now because of coercive penalties and subsidies…it is as if in 1990 the government decreed that we all had to buy Motorola Startac phones (the best at the time). It would… Read more »

Peter1
Guest
Peter1

Paul, I don’t think government is telling you which system to buy – are they?

Do you want to wait for the perfect system?

I think government should have laid some competitive ground rules, such as interoperability, I think that would have leveled the playing field on systems, allowing more competition.

Ron
Guest
Ron

Here’s the non-satire version of this:

J Am Med Inform Assoc. 2014 Jan; 21(1): 117–131.
Published online 2013 Jun 25. doi: 10.1136/amiajnl-2012-001419
PMCID: PMC3912703

Healthcare information technology’s relativity problems: a typology of how patients’ physical reality, clinicians’ mental models, and healthcare information technology differ
Sean W Smith1 and Ross Koppel2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912703/

Philip Green
Guest

Thank you for posting that article. It was quite mind blowing for me to read as my only experience with EHR’s is at the end user state. I have thought a lot about this. If I could ask for only one thing to change, it would be this: EHR’s seem to be built on the assumption that a physician needs and wants every piece of information about a patient on the screen in front of them at every second in order to make informed decisions. The opposite is true, at least as an ER doctor. I work in an environment… Read more »

Romy
Guest
Romy

I can totally relate as the wife of a (unfortunately) frequent ER patient. My husband has been battling CLL for the past 17 years. This past year he’s been admitted 8 times. One of those times it was from his PC doctor directly to the ER, where his ID band wasn’t working for the nurses. They tried for 15 minutes to order medicine to no avail until they figured out that they needed to get a new ID band on his wrist issued from the ER, not the doctor’s office. It was really frustrating for the nurses because they were… Read more »

Peter1
Guest
Peter1

Good link Ron, but not startling research conclusions. Narrowly focused and constrained computer requirements make it easier to disconnect people from reality – I think we’ve all experienced that even outside of medicine. The research also said paper can distort reality as well as: “Many times EMRs do a dramatically better job of reflecting reality than paper ever could”. There have been past discussions on THCB about doctors notes and the ability of the patient to get access to them to verify the doctor’s perception over reality and how misperceptions get passed to other caregivers. The point about getting HIT… Read more »

Teng Yan
Guest

Having worked at the ER not long ago, I’m chuckling at this.

I thank the stars that the hospital administrators at where I was at had way more sense than this. Checklists are good, but they need to integrate seemlessly into the clinical workflow, rather than impede.