A nurse I know just fired her gynecologist.  He had been practicing independently but recently “sold out” to one of our “not for profit”-seeking hospital friends.  If you think that this hospital bought his practice because they are not interested in profiting from this move, you need to follow this blog more closely. 

Back to the nurse I know.  Since her last visit to this doctor, the office has been taken over by the electronic medical record metastasis that has overwhelmed so many physician offices in the country, but is standard for hospital-employed doctors.  This is necessary, you see, so that the hospital (not wanting to make a profit) can track each and every move this doctor makes, each and every billable encounter (used to be called patient visits) and track and direct each and every referal this doctor makes, to be sure that no patient slips through the cracks of the hospital network physicians.  Nurse walks in to the office.  Staff can’t find her in the “system.”  “Oh.  That must mean you haven’t been in for a visit since we switched over.”  “Take this brochure and go to the phone booth down the hall and around the corner.”  Yes, that’s what she was told. 

It was here in the phone booth that the nurse decided it was time to change doctors.  You see, the purpose of the visit to the phone booth was for the nurse (the patient, remember) to speak to an electronic listening robot scribe, that was filling out a form on the other end of the phone.  The vast majority of the questions had to do with her insurance and benefits.  Very little had to do with her as a patient or any particular medical history or condition she may have had. 

Following this wonderful experience she walks in to the exam room where a nurse, without turning to greet the nurse in our little story, says, “have a seat,” while she types with her back turned the entire time, into the system computer.  Sometimes the answers to the typist’s questions fit in to the possible acceptable answers listed on the multiple choice format, sometimes they don’t. 

Unfortunately, most patients won’t fire their doctors for doing this.  These electronic records aren’t great just because someone on Wall Street says they are.  Patients hate this stuff, but put up with it because they don’t think they have a choice.  This doctor has lost a patient, but now doesn’t care, as no longer accountable to this patient, he is accountable to his hospital bosses.

Reporting from the trenches, attempting to show at times the ugly side of what all of those suffering from Hayek’s “fatal conceit,”  think are great ideas in medical practice(electronic medical records, etc), I’m signing off for now.  I have patients to see.

G. Keith Smith, M.D.