Oct 26th 2019,
14 tweets,
5 min read
Part of this stems from medicine “mission creep”, part from mandated data-gathering that is used for “studies” (shitty data as should be obvious here), and part from Doctors surrendering their profession. =>
“Mission creep” is a military term that means trying to go above and beyond your mission. This often has disastrous consequences. A classic example would be a pilot tasked with taking out two targets on a mission but seeing a third, destroying it, and going “bingo” fuel =>
Running out of gas. Crashing. Medicine is REALLY hard to do well. Focusing on the patient in front of you completely, making good diagnostic decisions, and instituting prompt treatment is critical, especially in the ER. It is NOT and exaggeration to say that doing this =>
Often is life v death for the patient. All extraneous distractions (speaking soecifiCalky about the ER bit peripherally about other disciplines) make the primary mission much more difficult. Having an EMR loaded with extraneous data is deleterious. Spending 20m =>
W the triage nurse entering all this crap helps no one but number crunchers and academics who crunch the shitty data. To show you how unnecessary it is in the ER consider this. If a 50 year old male presents with chest pain they are placed directly in a room=>
And and EKG, portable chest X-ray, IV, aspirin, and labs are all done somewhat simultaneously and within 5 minutes. =>
At the first indication that they are having an MI, they are taken to the cath lab by cardiology, ideally all within 30 minutes of arrival.
None of the other shit matters and often the chart will be put in the EMR with nothing other than DOB, meds, allergies etc... =>
As well, on a patient who is discharged from the ER with follow up with their primary care physician, the ER chart is typically 10-15 pages long, only a few paragraphs and labs relevant to the follow up. Some physicians type in ALLCAPS specifically to aid anyone =>
Looking at the chart to find the medically relevant information. And aside from this, as the most rigorously trained and qualified physicians in the world (there are other countries who have wonderfully trained and equally great physicians- not my point) =>
It is certainly within the doctor’s purview to ask questions about guns, car seats, swimming pools, alcohol, drugs, depressive symptoms etc... on a case by case basis and as indicated by the particular interaction. =>
Finally, as an example of the futility of this kind of data gathering. Every single service member visiting a clinic is has been given a suicide and depression screening questionnaire on every single visit to a military clinic now for well over ten years. =>
This has not impacted, at all, the rate of military suicides, nor, on my very large military base, did any of the completed suicides give any indication on these screening questions that they were depressed or suicidal. None. It’s garbage. My belief in the case =>
Of the military suicides, is that the screening questionnaires HURT the process because it’s easy to feel they substitute for eye-to-eye , unhurried, and thorough patient encounters. //
