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|Subject: Re: OT: Career crisis||Date: 10/16/2005 4:56 PM|
|Author: xraymd||Number: 212653 of 309314|
Greetings, Fuskie and everybody, I actually AGREE that it is high time (past time) for computers to enter medicine, including even a computer interface for entering data. I just don't agree that how it is being done where I work is working for me.
The docs who have adapted are able to sit with their patients, both facing the computer, and they talk and type at the same time, I can talk and WRITE at the same time but when I try to fuss with the current user interface, it's either that or pay attention to my patient but in the present environment, NOT BOTH. I've tried for months to become more fluent but it is not happening with sufficient rapidity to keep me as productive as I'd been before.
Some of the patients hate it, and they've left. Other patients are happy enough with it if their doc happens to be a maestro. On paper I am a maestro. On this computer system, I am a clumsy oaf who constantly forgets things and who has to ask the patient aspects of past medical history that on paper I would have ALREADY KNOWN and who causes delays when trying to print out Rx's. This interface and I are not seeing eye to eye. One of the bigger issues all summer is that we had a dearth of medical records staff so the xray reports and lab reports and notes from consultants were not getting scanned into the system - so when I went online to look for data to keep the patient informed, it was not there. My medical assistant and I took to separately photocopying important results and, in effect, running a parallel file system because trying to look for a document awaiting scanning meant, literally, searching through a huge, unsorted, photocopy-paper-sized box of documents on dozens of patients. In the 15 minutes alloted for a patient appointment, WHO HAS THAT KIND OF TIME? And this was becoming a daily event. And the parallel filing system, while allowing us to at least put our hands on pertinent data, was causing its own kind of time hit. I am told that the medical records staff are now replete and that scanning documents is back on track, but if we are in the midst of switching off of paper charting and onto electronic documentation and records storage/retrieval, one would think that we'd be right in line with how we at least USED to track and access patient records. Can you imagine having YOUR xray report buried at the bottom of a box? So it became a real challenge to be able to tell patients their results during their appointments. And even if it is improved, it is still not trouble-free, for the dates on the scan system are known to be buggy and I have to sometimes hunt through multiple electronic documents to find the one I am looking for - can't rely on the datestamp.
I actually cheer advances in technology that truly make a task easier and if it takes a learning curve then so be it. Certainly there was a learning curve involved in getting onto a personal computer and getting online. What I fault here is that I've been treated like I have to keep going at this like a battering ram and it's my tough luck that it takes me till past 9pm to finish the work. It's depleted me and that has sent up no alarm signals to the powers-that-be, despite my objecting to the schedule it was causing me to keep as long ago as last spring when I was 2-3 months into having gone live. I've been drowning and have not found a lifeline. That's what I consider to be the real issue underlying all of this: I am supposed to float and if I am sinking, then what message I've been receiving amounts to buh-bye. As I've said already, the management has not planned for failure. There has been no plan B. I've just been left to work this cockamamie schedule for months, even having said that it is taking me into the night to get the work done. And, trust me, I have said it more than once. What finally caught someone's attention is when the senior partner called me at home one of the nights he was on call to tell me about an admission of a patient I'd need to be seeing the next day in the hospital. He called at 10pm and I was STILL not home from work. My fiance answered and told him this and point-blank asked him "When are you going to get her some help? It's like this night after night." And I had already told the senior partner this weeks before.
The way I am going to find to adapt is most likely going to be outside this present position. I completely concur that needing to get electronic is the coming wave in medicine. But it feels like I've been pancaked by the present system and the present management attitude. If any of the other partners were struggling, alarm bells would be going off. But since I am the only one NOT adapting (in certain ways for some very good reasons) then the culture and I have a clash. For those who used to read the Ladies Home Journal magazine series on "Can This Marriage Be Saved?", the position I am now in is "Can This Job Be Saved?" and it's looking decreasingly likely and that is such a shame.
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