I walked into the hospital for my overnight shift through the ER. Always good to know what surprises they have in store for you. My colleague, whom I was relieving, looked upset. She gave me the thumbnail: “Four month-old there nearly three hours, looking toxic. Studies all in the lab, fluid bolus on board, BP acceptable, not great. Pharmacy won’t mix and send antibiotics, stating the ER’s computerized ordering system (CPOE) isn’t communicating with theirs.”
A simple problem – “Haven’t you called the pharmacy and asked for the antibiotic?”
“Yes, but this week, CPOE is in full operation. Administration mandates only electronic orders are acceptable.”
Ah, yes, our good friend the EHR. Several years earlier, our hospital converted to electronic notes. As a hospitalist, it wasn’t bad, except on busy nights. I sat with each family, looked them in the eye, jotted down notes, examined the patient, and then entered my note into the system. The system was decent. For physicians in practice it was harder: seeing 40+ patients daily, face-to-face patient encounters morphed into face-to-computer screen encounters, madly checking off boxes. (Where did the patient go?)
At endless meetings during our hospital’s enforced transition to CPOE, we saw screenshots of the system: awful! Every time I asked ‘why’, I was met with eye rolls and told to “accept this wave of the future.” MIS people had to train each physician (didn’t cost us a dime for this fabulous educational activity, but our MIS friends were no doubt paid for their time).
We entered a months-long period of CPOE trial. It took us far longer to ‘write’ orders under this system, and with each set of orders came a dozen pager beeps of questions from the nurses, pharmacy, and respiratory therapists. Soon came beeps from MIS telling us everything we did wrong.
Worst of all…the mistakes. A patient got Clonidine instead of Klonopin. Entire therapies weren’t administered, because in my haste to run to an emergency, I neglected to click on the correct drop down menu for pulmonary toilet. There were more mistakes under CPOE than I’ve ever seen in medicine. Whenever I raised my hand at meetings, I was nearly the only one complaining. We were told nuances of CPOE were beyond repair; they were part of the system the hospital purchased. (The billions made by software companies when EHRs became mandated must’ve been one doozy of a quid pro quo!)
Shocking, was the complacency of my fellow physicians. When did we become such puppets for our masters, the administrators? Hospitals and doctors need administration, but we don’t need the 4000% increase we’ve had since the 70’s.
Let’s get back to what really matters: the patient. At the moment I heard about not having crucial antibiotics for a sick infant, I snapped. I walked to the nearest phone and dialed the pharmacy, “Dr. Mass here. Why is patient x waiting for meds?”………(party line reply delivered)….”I see. You are going to mix up the antibiotics and get them to the ER in ten minutes. Otherwise, I will call the hospital CEO and tell him that I am going to tell the parents that their child is in danger because of hospital policy. I will not have some (un-publishable word) bureaucrat dictate my patient’s care. What? …Oh, thank you.” Coming clean to let you know how fun and liberating that moment was, as the ER staff stared at me in shock.
I don’t wonder why more physicians don’t complain; it takes time. We are knee deep in CME, MOC, state and hospital mandates, insurance company fights, on and on. No wonder patients say we don’t take enough time with them. Furthermore, 80% of physicians are hospital-employed. Buck the system, lose a job. If you aren’t hospital-employed, you are bogged down keeping your indie practice alive for the sake of the patients you love.
Back to the patient, who should come before all else. We have an unsustainable system that patients can’t understand, and docs have no time or power to fix. The only scenario in which physicians will regain power is the zombie apocalypse, or the ISIS infiltration, whichever comes first. In either scenario, the bureaucrats will no longer be useful, as they will be unable to deliver babies, remove appendixes, etc.
To physicians who remain complacent–allowing our current health care death spiral by not telling our patients and colleagues the truth, please find your voice. Unleash the power of your training and experience, and speak up. Ask your future self, amidst the rubble of tomorrow’s health care system , if you did the right thing by remaining silent. We owe thanks to the brave ones who fight.
There is a beautiful passage in Shakespeare’s Henry V, young King Hal’s speech to the troops before the battle of Agincourt: “and we few, we band of brothers…gentlemen in England now a bed shall…hold their man-hoods cheap while any speaks that fought with us upon St. Crispin’s Day.” I have two teens who want to become doctors. Someday, they can look into their mother’s eyes and know that I fought to make their lives and those of their patients better.
My patient did well. Blood culture returned negative, but what if the patient was frankly septic, and continued to lack antibiotics? Would you want that to be your child? Your grandchild? So the question remains: ‘When will more doctors stand up for their patients and themselves?