Health care confidential: In their words
Health care has changed significantly over the last 20 years. But how has this change impacted the ground-level patient care teams? We decided it was time to find out.
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From the pages of In Business magazine.
Last November, after having to switch my insurance plan for 2018, I did my homework to search for a new primary care physician (PCP) based on my personal criteria. The woman I chose impressed me with the ease and confidence she exhibited in her video, and I looked forward to meeting her.
I still do.
In January I called to schedule my initial meeting with her, only to learn her earliest available appointment was in August. August!
I was able to meet with a delightful physician’s assistant and kept the appointment with my PCP, but I couldn’t help but wonder if the delay was due to a lack of doctors, an overworked staff, or both? (I’ve since been informed my doctor will be on maternity leave in August, and our meeting was rescheduled to October.)
Then I was assigned to write a health care feature on the changing face of the care team and learned of another development that was top-of-mind with area medical professionals. It pertains to the challenges they are having with electronic medical records (EMRs), which have had a profound impact on health care since their widespread adoption over the past decade.
In addition to hearing their stories, we spoke to Dr. Chris Mast of Epic, the Verona-based maker of electronic medical records software, as well as KLAS Research, a Utah-based research firm that is out to prove that EMRs are getting a bad rap.
On the question of primary care, WEA Trust’s Tim Bartholow has his own thoughts about what’s happening in the health care industry, although they sometimes come with a bitter pill.
But to learn how patient-care teams have been impacted by all the changes, I needed to go to the source.
I am indebted to the four ground-level caregivers and two administrators who agreed to share their comments. Some agreed only on the condition of anonymity, which I eventually extended to all.
Their words follow in narrative form and speak for themselves.
Comments from the trenches
Nurse, practicing 30+ years
“I work in a specialty clinic and have also worked in a hospital. One of the biggest changes that most health care workers have found is in the electronic medical record. There are some drawbacks. Many patients complain about the loss of face-to-face interaction because health care workers need to complete the EMR in a timely matter. Physicians are limited in the number of patients they can see due to the time it takes to order tests, documentation, etc. The benefit of EMRs, however, is the continuity of care with the patients. The patient’s happiness is paramount but [the system] doesn’t work if the staff is overworked and stuck behind a computer.”
Primary Care Physician No. 1, practicing 11 years
“I knew early on that I wanted to practice medicine. I’ve always enjoyed science and critical thinking, so I felt medicine was the best way to tie in my passion for helping others. If a patient comes to me with a complex group of symptoms, I like to be on the diagnostic workup side of things.”
Not what I thought it would be
“I honestly don’t think a lot of young adults going into medicine really know what it will be like unless they have physicians in the family. Many of us who are first-time physicians in a family learn as we go.
“I knew medical school and residency would be hard, especially because it usually means giving up an entire decade of your life to train. You put your career on hold for about 10 years while all your friends have graduated and started their careers. It can create challenges when it comes to family and social life.
“I definitely chose the right field. I love what I do, but, at this point in time, I wouldn’t push my children into medicine unless they knew exactly what they were getting into. Things have changed quite a bit since I began this process.”
“I don’t think anyone could have predicted how much the practice of medicine would change, especially in regard to patient contact and developing patient relationships. EMRs have changed that tremendously. The majority of what we do now is done on the computer. For each hour of patient contact, we’re spending two to three times more than that on documentation and charting. We’ve become medical transcriptionists, which limits our ability to practice medicine and form those intimate relationships with our patients. We’re just trying to get by and get our work done.
“On the other hand, EMRs were very well intentioned and have many positives. Communication between physicians has increased both within and outside of our medical systems. Patient care has improved due to our ability to communicate with outside institutions and the ability to see consultant notes almost immediately. It no longer takes days to wait for the paper chart to arrive. There are built-in safety nets, too, that I believe have resulted in fewer medical dosing errors due to the safety systems in place.”
A typical day
“I’m a bit unusual. From 8:30-12:30 and from 1-5, I’m in direct patient contact. This is part of why I have trouble getting my charting done. Many physicians document in between appointments throughout the day. I want to spend as much time with my patients.”
Charting at home
“Everyone struggles and discusses the amount of time they spend on the computer. I’ve refused to let go of my time with patients for charting purposes, at least on my clinical days. I’ve been told I need to be more efficient, that I need to work on my exit strategy and manage my time better so I can complete my documentation during the day.
“So I do a lot of my charting at home when my kids are sleeping. There are many sleepless nights. I have Wi-Fi in my car so I can chart when we’re on a trip, and I also chart on flights. Everyone works outside of the clinic, but some of us struggle more with documentation because of the amount of time we’re spending face to face with patients, and it’s impacting our work-life balance tremendously.
“Once a week I get a note about the number of charts that are overdue and not done within the 48-hour required amount of time. But it’s not just the patient note that takes time. Between health care regulations, meaningful use, and best-practice alerts, we’re constantly clicking on things and either postponing or acknowledging reminders. Our inboxes are also full of MyChart notes from patients, which is basically free medical care. I spend almost an hour a day on MyChart alone.
“Yes, things could be easier, but I love practicing medicine! I have great co-workers, and we are making a difference. I worry though, that may be changing for a lot of people because their patient contact time has decreased significantly so they’re spending a third to a half of a day in front of a computer instead of in front of patients.”
Lower job satisfaction
“I think there are fewer people doing primary care because our work is feeling less meaningful. I don’t think people have the level of satisfaction they might have anticipated.
“Right now we’re witnessing the highest levels of physician burnout on record. I think a lot of that has to do with the increase in documentation demands and a decrease in meaningful patient interactions. Physicians are frustrated. It makes it harder for us to deliver the quality care we’d like to be providing.
“Still, I love what I do! My days are filled with joy except when I’m playing beat the clock because I’m running behind on documentation. We get fined for having records open too long, and we’ve been told they’ll even get stricter when patients start gaining more access to their medical notes.
“My argument is that the patient doesn’t care when their note is done. They need their questions answered, they want great medical care, timely callbacks, or responses to their MyChart questions. I prioritize everything except the notes because that’s what my patients care about.
“Fining is very common, but it also works. I’ve improved. I don’t get fined as much anymore, but it just feels wrong.”