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John Lennon’s Elbow | Humanities | JAMA | JAMA Network

  • 1.  John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 14:03
    Edited by Amanda Staller 05-07-2020 14:02
    If this is satire, it's good. If not, uh oh!
    https://jamanetwork.com/journals/jama/fullarticle/2765406

    BTW, this whole issue of JAMA on Narrative Medicine is worth a read, and not just because it includes pieces by Gordy Schiff, Gurpreet Dhaliwal, Don  Berwick & other friends of SIDM!


    Sent from my iPhone

    David
    David L Meyers, MD  FACEP
    410-952-8782


  • 2.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 14:31

    That is great, thanks David!  


    See also "Man's 4th Best Hospital," the new book by Sam Shem.


    https://www.amazon.com/Mans-Best-Hospital-Samuel-Shem/dp/1984805363








  • 3.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 16:19

    Anyone involved in inpatient care will be sadly familiar with note-bloat.  It is SOOOO horrible !

     

    It seems to have evolved out of the work-hours reformation: notes are written so that the next shift of doctors can get 'up to speed' on that patient without having to review the entire medical record (or, god forbid, talk to the patient!)  So chalk this up as yet-another example of unintended consequences.

     

    Clinic notes are another story altogether – note-bloat there seems to have evolved to maximize billing, as many articles have pointed out. 

     

      Mark

     

    Mark L Graber MD FACP

    Chief Medical Officer; Founder and President Emeritus, SIDM

    Professor Emeritus, Stony Brook University, NY

    607 305-0050

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  • 4.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 21:28
    There was actually a study looking at EMR notes from the emergency department and found that about 40% of the material in notes was either incorrect or simply made up when notes were compared to on-the-scene documentation by observers who shadowed the doctors.

    Reminds me of one of my own patients who I sent to a neurosurgeon for opinion on persisting radicular pain.  I got back a 3 page closely-spaced note with detailed history and head-to-toe physical exam (including rectal). I asked the patient what had happened at the visit: "He tapped on my knees and ankles and then went over the MRI with me."

    Brave new world!
    Ed
    Edward P Hoffer MD, FACP, FACC





  • 5.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 21:48
    Similarly, Alan Schwartz's latest in JAMIA <https://academic.oup.com/jamia/article-abstract/27/5/770/5824779> remarked similarly:

    While one cannot generalize about specific error rates based on a relatively small sample of physicians exclusively within the Department of Veterans Affairs Health System, the magnitude of the findings raise fundamental concerns about the integrity of the current medical record documentation process as an actual representation of care, with implications for determining both quality and resource utilization.
    The medical record should not be assumed to reflect care delivered. Furthermore, errors of commission-documentation of services not actually provided-may inflate estimates of resource utilization.

    Cheers,

    David





  • 6.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-08-2020 05:47

    Ed:

     

    This reminds me of medical school.  Because of the intense time pressure we were under during our clinical years (ten admissions per night in some cases) many of my fellow students began to abbreviate their H&P's and would then fill in the gaps with whatever came to mind.  Most got away with it but, on occasion, the staff physician, and more usually, the admitting physician would see through the con and call the medical student...and the resident...on the carpet.

     

    Worse, given the amount of time allowed physicians and other clinical staff to do an H&P it's almost expected that it won't be truly thorough.

     

    In fact, I have seen a cycle:  Efforts to increase revenue leads to decreased time allotted to the H&P because it doesn't generate income along with an increased time allotted to studies that do generate income.  This leads to decreased diagnostic accuracy which leads to increased malpractice law suits which leads to increased liability insurance for the facility which leads to efforts to increase revenue which leads to...

     

    And down we go.

     

    Mark Gusack, M.D.

    President

    MANX Enterprises, Ltd.

    304 5231-1980

    www.manxenterprises.com

     






  • 7.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 15:48

    A heady corrective to all those wanting to "do NLP" with clinical notes, presuming that the note mirrors reality.

     

    I suppose they do. Darkly.

     

    Harold






  • 8.  RE: John Lennon’s Elbow | Humanities | JAMA | JAMA Network

    Posted 05-07-2020 15:55
    I couldn't have said it better!
    Especially when assumptions are made that information in the note is both absolutely encoded and solely represented by "character-level" information (per Markov).
    Composition, rhetoric, discourse are all sorely lacking in the clinical storyworld...
    Cheers,

    David