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Subject:  Re: OT: Career crisis Date:  10/16/2005  1:06 PM
Author:  xraymd Number:  212641 of 310650

Greetings, blkmagwom, thanks so much for your input. As it turns out, I am a fast typist (I was actually a PROGRAMMER prior to leaving for medical school in 1994!). What is much harder for me is the wending through a byzantine set of modules, each of which has its own little rules for data input, many of which have checkboxes or radio buttons, and many of which require clicks to shut off pop-up boxes requesting more detail. And the WORST of which is that I am now required not just to type what I used to handwrite (that's not so very hard for me) BUT that I must, at the end of the patient encounter, be prepared to SEARCH over a specific database whose search terms are different in many cases from common medical parlance to try to find codes to assign to each of the diagnoses that I arrive at that I used to be able to handwrite without those codes (we have a professional coder on staff who assigns the codes). And that impacts my accustomed thoroughness - one of the things my patients say they most appreciate about me - because for every code *I* now have to hunt down and assign, that's yet another entire branch of modules I have to make my way through even when I already KNOW the code. Heaven help me if I DON'T already know it, because it's about a 50-50 chance it will be in the database. And again, I still have to spend extra time processing this info electronically even when I find it. The big kick in the head is that the program will literally NOT MOVE FORWARD unless all codes are resolved - so I end up with sessions that don't close and patients stacking up waiting to be seen because I am fighting with the computer. Thus I have taken to saving all my documentation for the end of the day, and that's why I've been in the office night after night after night until well after 9pm. I've been asked to be not just a physician anymore. I've been asked to become a data entry expert and a coding expert. And adding further insult to injury, if I manage to match a code to a diagnosis and wish to write prescriptions based on it, I have to continually re-enter my password for every single prescription I print off from the computer - and sometimes I can't even find the desired medication in the Rx database! Is it any wonder I throw up my hands and revert to paper and written Rx's? And then I have to record what I've done for later transcription into the computer.

Can you hear the screaming from Tucson yet? :-)

The equivalent to what you proposed, regarding dictation as a form of one level of indirection of data entry into the computer, would be simply to let me do what I have DONE SUCCESSFULLY TO DATE. That is, allow me to continue paper charting and have someone else input my patient encounters on paper into the computer asynchronously, rather than MY doing it. My handwriting is perfectly legible (so I am told). I have always written down in duplicate what Rx's I've written and I have always put all of my diagnoses on the checkout ticket as well as on my assessment and plan on paper - I just never b