Surgeon at the Computer

I was recently asked when and what I would write about in this blog. I said I’d know whenever it hit me. In this case, I know because it’s what I wanted to hit: this computer.

The reality of medicine is not cutting edge science, robots, minimally invasive procedures or a tiny incision as distant as possible from the site of interest. It’s electronic medical records or EMRs. That’s what some call it. In my office, we refer to it as PITA. I don’t mean a tasty little sandwich…I mean a pain in the ass.

I spend more time sitting here at my computer typing in an encounter for a patient than anything else I do in my office, and that includes actual surgery and other office procedures. The way medicine used to be was you would meet a patient, visit, perhaps take some notes. I would routinely write in the phonetical spelling of their name if it was a tricky pronunciation or write myself a note about their job, their family so next visit I am sure to make a personal reference. You looked people in the eye when you met them, shook their hand.

The ‘paperless’ world of electronic records has killed that reality. In some offices, you talk to the back of someone’s head while they type what you tell them or the top of their head while they enter into the laptop. In my office I forbid that: too impersonal. I have created cheat sheets to take into the room to make notes. Mind you, ‘paperless’ has turned into three times as much paper around here for this reason but so be it. I can visit like I always did. Let the time get away from me…talk about anything but surgery sometimes. It is so great.

Until I have to come back here and type it in. I am a good little typist. It’s a funny thing for people of my generation. I’m only 46 but even when I was in high school we took a semester of typing. Good old fashioned typewriter typing. There were no computers then…it was pre-1987. Just one semester of typing and I remain pretty good at it. And that’s a good thing since it defines my day. I have a cheat sheet in front of me right now with someone’s breast measurements on it that I wrote down during a breast augmentation consult. The computer is SO SLOW today that I have been trying to get this information entered for over an hour. I gave up and came over here because this is fast….I can get words out as quickly as they enter my stream of consciousness. Lucky for you I can filter the four letter words here that I emit regularly while in the electronic medical record.

The tools of my trade are really supposed to be a scalpel, some instruments, maybe a syringe of liquid youth. It would appear I should just consider myself lucky when that’s what my hands are doing, not strapped to this keyboard entering statistics, data, and numbers. There is nowhere in the electronic record to document the personal details. I remember much of it myself: if you spend time genuinely getting to know someone, even if it’s a brief encounter, you should remember. But no side notes about your last conversation, nowhere to document that phonetical cheat for the proper pronunciation of a name so someone feels special. There is a template we have to use to record an office visit or an office procedure. It is a template derived from General Surgery because the system does not recognize Plastic Surgery as an entity of its own. Wow, we feel even more personal and special now.

I am too young to be set in my ways and young enough to have sufficient technically savvy that I know my way around a computer. As noted, I’ve got pretty sexy typing skills for that one semester almost 30 years ago. The rub with the world of EMRs is that this is not what I signed on for when I decided to go to medical school to be a surgeon many, many years ago. Wasting my time waiting for the computer to process my entries then hit ‘Plan’ after I link it to the diagnosis code then write out an assessment and determine a visit code is not my cup of tea. Give me a pen and paper and a chair to sit across from someone while I get to know them and their concerns any day. Since I cannot control or avoid this, I will suck it up, buttercup, and keep typing.

So ends this fury blog. Back to work…

Here’s up to it!