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Wednesday, March 9, 2016

An impatient patient

There are days when the medical profession stretches my patience to the breaking point.

I called a provider today to ask them to forward my daughter's medical records to their new practice. The office manager reported that I would have to come into the office to fill out a records request form.  I told her that under HIPAA, I need not be required to come into the office to complete such a request. I'll note (but didn't go into that detail) that furthermore, since this request is for treatment, it does not even need a request from me, it could come from my daughter's new provider.  Why do I need to do this?  Because my current provider doesn't have access to the immunization registry that my previous provider reported her immunizations to.  Why?  I have NO clue!  And for this privilege of populating this providers knowledge tables, I will pay for a level 3 new patient visit, which is necessary in order to obtain an accurate physical examination from this new provider, but is somehow not covered by my insurance policy (although the physical exam is).

On the same day, I listen to multiple medical professionals go on and on (and on and on) about the value or lack thereof for "No Known Allergies", and why, if it is only temporally valid, need it ever be recorded.  Do these people even practice?  In a doctor's visit on Monday my wife talked to her provider on three separate occasions regarding her treatment, medications, et cetera.  And in between each of these discussions, the provider had seen another patient or looked at another chart.  Are providers so good that their memory of who among the 30 or more patients they see day has which allergy is correctly aligned with the patient in front of them?  Some days I cannot remember which call I'm even on, and my schedule looks nothing like a doctor's.  They are no more superhuman that I am.

And while I completely respect my Doctor's need for safety, would it really be so bad if, when stopping to ask me the same question for the 14th time in the last two years, he bothered to check to see what they already should know, and confirmed it, and any possible changes, rather than make me REPEAT and possibly forget something I said before?  I know this can be done well, because I've seen it done a number of times, by at least three different providers.  But I only see this behavior about 10% of the time.

And finally, if I hear one more complaint about how an EHR interferes with patient face time, I think I might just cry.  I've seen this done well too, with two different systems, by the same provider (my former PCP).  This is a skill, and you HAVE to practice it, consciously, until it becomes habit, or else you will develop habits that will make your patients dislike your behavior. However, don't blame your behavior on tools used poorly. Learn to use the tools well.  It can be done, but you have to THINK about it, and do so critically and consciously.

   Keith



4 comments:

  1. I don't know if your statement "I told her that under HIPAA, I need not be required to come into the office to complete such a request" is correct. My understanding is that while HIPAA does not require a records release for treatment (sending records to another doctor) it also does not prevent offices from setting policies that require a release form in these cases. A healthcare attorney confirmed this, while also stating that office need to be careful to not block access to the medical records. Why would an office want a release? The main reason is usually as an extra legal protection, but there may be other reasons (tracking why patients may be leaving).

    There is also a difference between a PCP referring a patient to a specialist and sending medical records (without a release) and another doctor asking for medical records, out of the blue, when the PCP isn't sure that the patient wants that doctor to have the medical records.

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    1. They are indeed allows to require a written request. They are not permitted to make it challenging by requiring me to come into the office to complete it, nor must I use their form to make it.

      As for treatment, both cases are clearly treatment related. If they are unsure as to why the other doctor is asking for the information, they may indeed handle it according to their policy, but HIPAA does not require them to have my consent to exchange it, even if the other provider is not part of their own organization.

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  2. First, enjoy your blog. Now the but...
    Just because you've had doctors who overcame EHR's and managed to provide satisfactory patient "face time", doesn't mean that they should HAVE to continue working around clunky software/interfaces. You have it backwards. I have seen well designed technology permit good patient "face time" without doctors HAVING to practice workaround "skills". Suboptimal technology HAS to get better instead. Are machines serving humans here or vice versa?

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    1. I'm not backwards. When using ANY system, regardless of how easy it is to use, it becomes the focus of the user's attention. Remembering to pay attention to the other person in the room requires awareness of where your attention is. Watch anyone using ANY computer system as part of their job function that also involves people interaction, and you will see the same thing. Many (in fact most) will focus on the system rather than the person. To overcome that tendency one must practice paying attention to the person. Yes, a clunky system will make it harder to pay attention to the other person, but even a well designed system attracts its users attention (consider the iPhone ...).

      Does that mean user interfaces couldn't be better designed? No, and I never said that.

      Keith

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