The recent patient who thought she was dying of cancer inspires me to comment on how information, and its accurate communication between doctor and patient are so crucial.
OK, a high sounding platitude. But I am always crying to my patients about how hard it is to get information. And how information is absolutely essential to know how to treat you.
If I don’t know you had a heart attack, I don’t know to get serious about trying to modify your risk factors (blood pressure cholesterol etc). If I don’t know you had breast cancer, I might not be thinking that pain in your back could be metastases. If I don’t know you have already gone through an extensive work up for hematuria (blood in your urine), I’m going to be ordering IVP’s and all sorts of other expensive/invasive tests (like having someone stick a scope up your willie.)
In the practice I am in, we have electronic medical records (EMR). Some others in town do also, including the local hospital - but because of lack of “connectivity” (the ability of systems to talk to each other) we have to go to their site and down load ER records, Discharge summaries, labs etc in hard copy.
I shall spare you the rant about trying to read these, because the system has been designed by geeks, lawyers and coders - so it’s a glorified billing template with a mass of CYA information you don’t want to know, like how the patient was transported to the x-ray, and a bunch of other stuff the IT guys think you have to have, all of which does a good job of burying the information you really do need. But I digress.
Some other docs in town have EMR, but when they do, we can’t access their records. So when I send a patient to a specialist, I’m usually in the dark, except if I occasional get lucky and one of these guys sends me a perfunctory letter - a few weeks later.
Most amazing of all, I find myself in agreement with Sen. Chuck Grassley because he is trying to reform electronic medical records. Mainly he seems to be beating on the companies about systems that; misread intracranial pressures; calculate wrong drug dosages; appear to have gag orders that stop anyone disclosing their faults, and a bunch of other shady sounding business practices (but hey, we’re in the land private enterprise). But, bless his cotton socks; he is also reputedly on the industries case about “connectivity” also.
Apart from getting information from other providers who get to broddle with your patients, getting information to the patient, in an accurate from, is another challenge. I am prompted to write about this now because of a woman from whom I recently removed what I thought was a sebaceous cyst. Well, it turned out to be a lipoma (a very common and very benign growth in the fatty layer just under the skin).
Although she was coming in soon to get her stitches out, I diligently reported on the pathology, that it was a lipoma, and sent this info’ to the message nurse to call the patient.
By the time I got to her, at her follow up visit, she had calmed down a bit, because my wonderful nurse had put her strait. But she had been in panic mode since getting the phone call from the message nurse, because she had heard, not “lipoma”, but “lymphoma”.
It’s like the joke about the old fart in hospital with the oxygen mask that keeps asking the shy and discombobulated student nurse “are my testicles black?” Only after she finally, with great embarrassment and desperations, lifts his gown and checks out his stuff, does she remove his oxygen mask to hear him better and find he is asking, “are my test results back?”
