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Why should physicians have to enter orders in the computer?
Topic Started: Aug 7 2015, 05:22 PM (382 Views)
Copper
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http://www.kevinmd.com/blog/2015/08/why-should-physicians-have-to-enter-orders-in-the-computer.html

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Why should physicians have to enter orders in the computer?

So, there I was yesterday, working frantically to keep myself above the water level of the rapidly rising swamp of patients. Navigating, haltingly, the onerous and demonic EMR. So I thought I ordered three nebulizers, but it was only one. The respiratory tech approached me and informed me that she would put them in, but only this time. That I’d have to do them myself for a while to learn, or I’d become spoiled. You know, spoiled. That is, I might spend time with patients instead of the keyboard!

I don’t understand why it’s so much better for me to enter orders than for the secretary, or even nurse in some instances, to enter them. Other people still vastly outnumber doctors in most departments. Further, I still work in two places where I check the box on the form, or tell the nurse/secretary, and they enter it into the computer.

Why was that so bad? Were there that many errors? Were the secretaries that overworked? Is the use of language, as in, “Mr. Schwartz in room 5 needs CT angio to rule out PE,” so utterly fraught with confusion and uncertainty? Are physicians of such marginal value that we need to add tasks to the already challenging data entry and (secondary) patient care that we need to be trained to enter orders ourselves? What’s next, perform our own CT scans, so we get it right?

And in an age of nurse empowerment, are nurses so unworthy of our confidence that they can’t do anything until it’s in the computer? I swear, I expect to someday say “start CPR” and be asked, “Did you put it in the computer yet?”

We have crossed the line in the sand, passed the zero moment. We have jumped the shark and all the other metaphors I can imagine. Charting is bad enough, but I see nothing beneficial from having me sit at the desk and try to make decisions about life, death and disability, all the while trying to figure out how to enter a timed troponin level, even as the next stroke victim rolls through the door.

“Something,” as my patients used to say, “has got to be done.”


The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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George K
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Quote:
 
Why should physicians have to enter orders in the computer?

Because the government says they have to, under pain of reimbursement cuts.

That's why.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Mikhailoh
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If you want trouble, find yourself a redhead
Physicians make money and must be punished for it.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Copper
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I knew G would like the story.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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George K
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Copper
Aug 7 2015, 05:42 PM
I knew G would like the story.
Working with a plastic surgeon today who was bitching about this exact topic. It's remarkable how less efficient we have become. The simple idea of ordering a medication has become a 14-16 click adventure, as I've posted before.

He said, "If I could, I'd go work at Starbucks, but I can't afford the tail. I'm screwed."
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Copper
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Here is some local news announced about a week ago.

The money is getting bigger and bigger.

http://fcw.com/articles/2015/07/29/dod-dhmsm-award.aspx

Quote:
 

DOD awards massive health records contract

The team of Leidos, Accenture and Cerner is getting the Defense Department's massive electronic health records contract – and the military appears to be getting a bargain.

The Defense Healthcare Management System Modernization, or DHMSM, contract was initially estimated to have an $11 billion lifecycle cost through 2030, but the actual award announced July 29 is for a fraction of that amount: $4,336,822,777 over 10 years if the options are exercised.

"We feel confident that we made a good source selection," said Chris Miller, Defense Healthcare Management Systems program executive officer, on a call with reporters. "Competition has worked, costs have come in below our estimates. We're very happy with the results we've got."

What's next

Change management will be critical, Miller noted, saying more than 25 percent of the contract will go to support and training to ensure clinicians know how to use it.

"Today is just the beginning," he noted. "The hard part is about to start."

DHMSM is scheduled to be tested at eight sites in the Pacific Northwest starting at the end of 2016, with a full rollout by 2022.


The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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George K
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Finally
We now have an electronic anesthesia record. The gas flows, vital signs are all entered automagically. All I have to do is click on various macros to document how I intubated, what drugs and how much I gave etc. It is easier, in the sense that I have to pay less attention. Why would I bother writing things down, making cryptic little marks for blood pressure and heart rate, when the machine does it for me?

Because I have to stop, look at the monitor and WRITE IT DOWN.

As they say, anesthesia is 99% boredom, and 1% sheer terror. If you increase the boredom, you'll start to miss things.

And then, sometimes, things go "poof!" Two weeks ago, I took a patient to the recovery room, and despite my record being complete in the OR, nothing had been saved, and none of my record was findable. In 40 years of working in an OR, I never lost the paper copy. But now, I have lost an electronic one.

And thanks, Copper. I was sitting here, having a nice (inexpensive) Scotch, and you managed to get my blood pressure up.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Copper
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Shortstop
Software salesmen have to eat too.
The Confederate soldier was peculiar in that he was ever ready to fight, but never ready to submit to the routine duty and discipline of the camp or the march. The soldiers were determined to be soldiers after their own notions, and do their duty, for the love of it, as they thought best. Carlton McCarthy
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Mikhailoh
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If you want trouble, find yourself a redhead
Copper
Aug 7 2015, 06:20 PM
Software salesmen have to eat too.
Same as worms.
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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bachophile
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HOLY CARP!!!
One advantage of academic hospitals

I have lackeys and minions

They are called residents

I command . They scurry. If I need a shoeshine they will be on their knees.
And if I need a CT Angio, they will be clicking.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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Mikhailoh
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If you want trouble, find yourself a redhead
It's good to be doctor king. :lol2:
Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball
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Jolly
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Geaux Tigers!
Better to be a resident than an intern...
The main obstacle to a stable and just world order is the United States.- George Soros
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George K
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Finally
Jolly
Aug 8 2015, 03:13 AM
Better to be a resident than an intern...
Better to be an intern than a medical student.

Stercorum declinum est.


(I loved being an intern)
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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Jolly
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Geaux Tigers!
Shiite happens?
The main obstacle to a stable and just world order is the United States.- George Soros
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jon-nyc
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Cheers
George K
Aug 8 2015, 03:48 AM

(I loved being an intern)
I'm curious - do you choose a specialty prior to becoming an intern? So when you're interning, you are interning as an anesthesiologist?
In my defense, I was left unsupervised.
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George K
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Finally
Jolly
Aug 8 2015, 05:29 AM
Shiite happens?
No. Shiite runs downhill.
Jon
 
I'm curious - do you choose a specialty prior to becoming an intern? So when you're interning, you are interning as an anesthesiologist?
As a junior medical student, you rotate through various specialties: pediatrics, OB, psych, neurology, internal medicine and surgery. One of the weeks of the surgical rotation is spent on anesthesia. As a senior, you have 12 weeks of internal medicine, and then 24 weeks of electives (in 6-12 week blocks).

I enjoyed it, and I had an opportunity to do a 12 week rotation in anesthesia. It was at the VA where I was given a lot of responsibility and a long leash. I had fun - a lot of fun. It was hard work, and long hours, but the teaching and experience were fantastic. That's what made up my mind.

I applied for an anesthesia residency, and got in. Since I had already demonstrated my extraordinary talents as a senior medical student, it made the process easier; the faculty knew me.

At that time, the anesthesia residency was two years, with an optional 3rd year fellowship (I did mine in intensive care and cardiac surgery). However, before that you're an intern for a year. Our program was set up so that the rotation included 6 months of ward medicine, a month of ER and a month of ICU. Then, you had 4 months of electives. I did a month of neurology, a month of pulmonary medicine, a month of radiology (in August, in Chicago - no call, no weekends, no nights) and a month of intensive respiratory care. Those months are in no specific order, by the way.

So, to answer your question - by the time you are an intern, you've decided what you want to do. I was fortunate in that I had a lot of experience in my chosen field beforehand, so I *really* knew what it was like.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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jon-nyc
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Cheers
Thanks.


I often wonder how people end up in fields like infectious disease, GI, or even pulmonology. Those are probably not top of mind when applying to medical school.
In my defense, I was left unsupervised.
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bachophile
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HOLY CARP!!!
jon-nyc
Aug 8 2015, 06:04 AM
Thanks.


I often wonder how people end up in fields like infectious disease, GI, or even pulmonology. Those are probably not top of mind when applying to medical school.
those are all internal medicine subspecialties

people gravitate to what interests them or whats available...as in any profession
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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George K
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Finally
Well, those specialties get exposed to you when you're doing your rotation as a medical student. Usually you have a patient that needs a pulmonary consult, and you get to see the thinking behind that.

Let's say that you want to go into internal medicine. You complete your 12 month internship (probably similar to mine, but without the electives), and you learn the basics of patient care, and, in 10 months probably encounter pretty much everything that's common.

As a medical resident, you have rotations as well, but your job as a resident is twofold:

1) Supervise the interns and medical students who are doing the gruntwork of patient care (ordering tests, admitting, etc).

2) Learn. Read. Learn Read.

As a resident, you will also have your rotations - pulmonary, ID, cardiology, etc. On those rotations, YOU are the consultant that the intern or the floor staff calls. You do the initial evaluation, and report to your supervisor (either a fellow or attending doc) what you found. Then you write up the consultation report.

That way, by the time you've finished your 2 years of medical residency, you can decide if you want to specialize in one of those fields or go out into practice as an internist.

Surgical training is very similar, but with more abuse and hatred.
Edited by George K, Aug 8 2015, 06:13 AM.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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brenda
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..............
George K
Aug 8 2015, 06:12 AM
... very similar, but with more abuse and hatred.
Und so ist das Leben, hart, aber brutal.
“Weeds are flowers, too, once you get to know them.”
~A.A. Milne
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Axtremus
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HOLY CARP!!!
George K
Aug 8 2015, 06:12 AM
Surgical training is very similar, but with more abuse and hatred.
Yeah, but they get to sleep around with other good looking doctors, as shown in Grey's Anatomy.
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bachophile
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HOLY CARP!!!
absolutely

surgeons love getting their hands warm and wet.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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Jolly
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Geaux Tigers!
Are there any hand-eye coordination tests or fine motor skill tests given to surgery resident applicants?
The main obstacle to a stable and just world order is the United States.- George Soros
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George K
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Finally
Jolly
Aug 8 2015, 10:35 AM
Are there any hand-eye coordination tests or fine motor skill tests given to surgery resident applicants?
Not as far as I know. But there are a few thoughts that spring to mind:

1) Dental schools used to have a criterion for admission: you had to carve something out of a block of (I think) chalk. Screw it up, find another field.

2) Surgical residents are constantly re-evaluated as they work. I'll defer to bachophile, but a good surgeon is 90% judgment and 10% hand-eye coordination. We have a guy whom I would consider mediocre, but he gets great results, his patients love him and he has few complications. That matters - a lot.

3) One of my colleagues used to say, "You can be the smartest scientist in the OR, know all the current literature, and understand all the physiology and pharmacology. You can take an anesthesia machine apart and put it back together in your sleep. But, if you can't put the tube in, you're no damn good."

Assemble all 3, and you'll understand.
A guide to GKSR: Click

"Now look here, you Baltic gas passer... "
- Mik, 6/14/08


Nothing is as effective as homeopathy.

I'd rather listen to an hour of Abba than an hour of The Beatles.
- Klaus, 4/29/18
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bachophile
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HOLY CARP!!!
Quote:
 
but a good surgeon is 90% judgment and 10% hand-eye coordination


ok but maybe id skew it to 80%-20%

if you aint putting your needle exactly where you want it to be when suturing a blood vessel or bowel, then practice a bit.
"I don't know much about classical music. For years I thought the Goldberg Variations were something Mr. and Mrs. Goldberg did on their wedding night." Woody Allen
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