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URL:  http://boards.fool.com/i-havent-read-through-all-of-the-responses-yet--23182250.aspx

Subject:  Re: OT: Career crisis Date:  10/18/2005  8:07 PM
Author:  ptheland Number:  212800 of 308782

I haven't read through all of the responses yet - the thread has gotten pretty long - but I thought I'd share a few thoughts.

I'm not in medicine, but am a professional (a CPA). Especially during tax season, I see clients, have to document files, prepare reports, and communicate it all back to clients. In a sense, it's not too different from a physician. Except, of course, that if I mess up, people don't die. They just have to pay money. (Which, for some, is not too different. <grin>)

As a patient, I like the concept of EMR. It makes a lot of sense. No confusion about the doctor's handwriting or dictation, either in the records or on the communications with others in the health care process (like prescriptions, orders, and the like). Conceptually, there can be a double-checking for potential problems (drug interactions, diagnosis that is inconsistent with the symptoms, prescriptions that are inconsistent with the diagnosis). From that standpoint, I would think that EMR could be a good thing.

But for it to be actually work in practice, it has to be a system that the physician can work with. Some learning curve should be expected with any new system. But if you're not getting up the learning curve, there is probably something wrong with the system. OR the system is not designed to work the way you work. Example:

I've taken the bulk of my individual tax preparation practice paperless. I interview clients, scan documents, create backup documentation, and produce a tax return with only the final product typically being on paper. It works because I designed the process to work the way I work. My business partner likes the idea as well. But he has been basically unable to implement my process. Why?

Two reasons, really. Mainly, we work differently. I like to gather the information, input it directly into our tax software, and do the documentation of our files as I go. All of this is done while the client is sitting with me. He prefers to get the documentation from the client, review it with the client, and then pass it all off to someone else to do the data entry. My system won't work for him, because he uses a different process. Secondarily, I'm not really sure he wants to go paperless.

I suspect there are some of the same issues working for you. If you had an EMR system that worked the way you worked, my guess is that you'd be all over it. The problem is that this system and you have different ways of working. Unfortunately, there are only two resolutions - the EMR system goes, or you do.

As a professional, I'd prioritize things this way:

1. Patients. Don't do anything that would jepordize the patients. As someone suggested, perhaps you greatly increase the time with each patient so you can (slowly) work through the EMR system. Or maybe you engage in outright rebellion and go back to paper. Whatever it takes to keep from making a mistake with the patient care.

2. Yourself. You have invested a great deal of time and money to get your professional license. Don't do anything that would endanger that license or your professional reputation. I suspect this is closely tied with number 1. Malpractice cases just can't be good for anyone. But it also includes handling the professional dispute with your managing MD's professionally. I imagine that would involve everything from consulting with them about the difficulties you're having to resigning your position rather than let yourself get fired. (PS - if you resign, you'll have a whole lot more time to job hunt! And a good quality professional like yourself WILL find another position. So don't let the illegitimate children get you down.)

3. The practice. The profitability and health of the practice need to come last. If the management of the practice has made a bad business decision, they need to suffer the consequences. That undoubtedly means some kind of loss - loss of the investment in the EMR system, loss of profitability, loss of good quality staff, and perhaps the loss of face. The last loss is likely the hardest for them to face. Most entrepreneurial doctors I've met are very egotistical. They don't like to admit mistakes. And they can behave very irrationally when faced with the possibility of losing face.

That's a lot of rambling to say this: you're a good doctor and a good person. It's tough right now, but in the end it will work out. It may get tougher, but you WILL get through whatever needs to be done to improve the situation. I have faith in you.

--Peter
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