Help Your Provider, Help Yourself

I was eating dinner the other day with one of the healthiest appearing 62-year-old women I've ever met. She was vibrant, active and looked 15 years younger than her age. She said that she sees her doctor once a year and every year her doctor appears a little older, a little more harried, and little more distressed. She said, “I just want to give her a hug and tell her everything is going to be okay.”

The truth is that with decreasing reimbursements, liability concerns, office over-head expenses, personal debt concerns, more regulations, the need to see more patients in fewer hours, etc..., many providers feel quite frazzled. I believe some of this stress also occurs from the technological disruption which is occurring in the medical environment. Providers are not Luddites. Most providers I know love using their I-phone, and apps such as Epocrates which allows them to search medications or using web based resources such as E-medicine or Up-To-Date. However, many electronic medical records (EMRs) are not necessarily doctor-patient friendly. Rather, instead of the computer working for the patient and physician (as in the case of Epocrates and Up-To-Date), often providers feel they are working for the computer and they must adapt to it. For instance, here is a discharge note I received from an excellent cardiologist just last week. This is taken verbatim. “Please note that it is difficult to give the exact instructions of amiodarone on our electronic medical record system; but the fact that the patient will take 200 mg twice a day of amiodarone for 1 week followed by 200 mg daily has been explained to the patient and his family members.” It is not the fault of the drug or the physician, but the electronic medical record simply does not allow the input of such directions. Overall, it is a difficult transitions for many providers which I hope will work out for the best, particularly for the patient.

Lastly, new coding guidelines (called ICD-10) require such precision that in the future I am not sure how providers will be able to performs such tasks without either a medical scribe or a more enhanced artificial intelligence build into the medical record. To give an example, below I created a simple medical narrative and how it could be coded with the new ICD-10 guidelines. It could be funny, until you realize all the codes are real.

“John Doe drank a little and bet some money on the 2^nd Annual Llama and Camel Race at the Henderson Race Track. Unfortunately, he drank a little too much, tripped and fell on the driveway outside a local mobile home but was able to regain his balance before falling into a telephone pole and then, catching his balance, falling into it again. Undeterred, he decided to get on one of the llamas himself and ride off into the sunset, but was unfortunately hit by a 1994 Chevy Malibu. Thrown off the animal, he suffered a tri-malleolar fracture and appears to you dishelveled and slightly drunk.”

Now, CODE IT!

Y92024 Drive of mobile home as the place of occurrence of the external cause

W22.02XA Walked into lampost, initial encounter

W22.02XD Walked into lampost, subsequent encountered

V80.919 Hit by motor vehicle while riding an animal

S82.851A Initial encounter for closed fracture of tri-malleolar fracture

R46.1 Bizarre Personal Appearance

Such coding accuracy is often not taught in medical school or residency and requires a great deal of understanding and effort by the provider. Lastly, the simple basic medical narrative which tells of the patient's very real concernces and conditions can get lost.

So, in an effort to “do no evil” as Google might say, using Microsoft Word, my program director, Dr. Michael White, led a simple task force of myself and a college student to create a Microsoft Word template for an individual to construct his/her own medical summary. This can then be handed to the provider by the patient. It's a simple template which allows you to fill in your own medical history. Here is an example.

It can take a little while to accomplish depending upon your medical history but I believe it can be useful for both yourself and for the provider caring for you. One patient gave it to his doctor, and the physician actually started to cry because it was so useful for him and the medical record in general.

I do not know how to embed a formatable Microsoft Word document in Blogger, but if you would like to email me at delippman@yahoo.com with subject line, Medical Record, I will send you a copy for free.