M.D.- A Medical Doctor or a Medical Documenter
How did we come to this point? The core job of a provider is to deliver safe, convenient, less expensive high-quality health care. However, during the past few decades, our attention has increasingly shifted towards proper documentation for different reasons- medico-legal and appropriate compensation for our work. Similar rules do not apply to other service industries, e.g., car dealers or attorney services. How often do we ask for documentation of the performance of their work? How often things go wrong? Healthcare professionals, especially physicians, are considered the most trustworthy and ethical in the US. Despite this, we are asked to provide evidence for our work and billing. Granted behavior of some clinicians occasionally deviated from moral principles, but does it mean the whole community of millions of health care providers is punished for it. Several studies report physicians spent an average of 5 minutes in direct patient care and 10 minutes on desktop. A recent study shows a primary care physician generates $420 per hour in direct patient care but drops to half per day due to EHR usage. It has also resulted in several unintended consequences- less patient and clinician satisfaction, burnout, accessibility challenges, long queues, increased medical errors, and distrust in the system and administrators.
The median length of the clinical notes in the US is about four times the median length in the rest of the world. However, little evidence indicates it translates into better health care. So why so much stress on notes? To satisfy regulators, payors, and the legal system. If there was ever a worst phrase or sentence written in health care, it is the mandate, “if it wasn’t documented, it didn’t happen.” It is outdated, incorporated on the behest of attorneys without any relevance to health care quality. In a published Institute of Medicine now National Academy of Medicine (NAM) report “Crossing the Quality Chasm: A New Health System for the 21st Century,” little guidance was provided to achieve the lofty goals. Twenty years forward, little progress has been made on quality performance across the board. Several factors are responsible for it but lack of evidence based policies are potentially constitutes a major barrier.
Evidence-based healthcare is delivered in a system bounded by rules and regulations. Without evidence-based SMART policies, we may perhaps be doing unintentional patient harm. As a healthcare faculty, we should not accept rules coming out of the bureaucratic system, but demand those policies be evidence-based. It is our moral and ethical duty under the “Hippocratic oath.”
